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The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

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A Capsule Commentary to this article was published on 08 August 2013

ABSTRACT

BACKGROUND

Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear.

OBJECTIVES

(1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES.

DESIGN

We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region.

MAIN MEASURES

Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient’s zip code.

RESULTS

Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P < 0.001), household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3 % vs. 42.5 %, P = 0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66–0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68–0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates.

CONCLUSIONS

Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.

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Abbreviations

NAMCS:

National Ambulatory Medical Care Survey

NHAMCS:

National Hospital Ambulatory Medical Care Survey

NCHS:

National Center for Health Statistics

CDC:

Center for Disease Control and Prevention

NDC:

National Drug Code

ED:

Emergency Department

REFERENCES

  1. Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11:S63–88.

    PubMed  Google Scholar 

  2. Fortuna R, Robbins BW, Caiola E, Joynt MR, Halterman JS. Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics. 2010;126(6):1108–16.

    Article  PubMed  Google Scholar 

  3. Phillips DM. JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA. 2000;284:428–9.

    Article  PubMed  CAS  Google Scholar 

  4. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299(1):70–8.

    Article  PubMed  CAS  Google Scholar 

  5. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;269(12):1537–9.

    Article  PubMed  CAS  Google Scholar 

  6. Epstein AM, Ayanian J. Racial disparities in medical care. NEJM. 2001;344(19):1471–3.

    Article  PubMed  CAS  Google Scholar 

  7. Bazarian JJ, Pope C, McClung J, Cheng YT, Flescher W. Ethnic and racial disparities in emergency department care for mild traumatic brain injury. J Acad Emerg Med. 2003;10(11):1209–17.

    Article  Google Scholar 

  8. National Center for Health Statistics. NCHS public-use data files and documentation: National Hospital Ambulatory Medical Care Survey (NHAMCS)—2006, 2007, 2008, 2009. Available at: ftp://ftp.cdc.gov/pub/health_statistics/nchs/dataset_documentation/nhamcs.

  9. Pollack CE, Mallya G, Polsky D. The impact of consumer-directed health plans and patient socioeconomic status on physician recommendations for colorectal cancer screening. J Gen Intern Med. 2008;23(10):1595–601.

    Article  PubMed  Google Scholar 

  10. Green CR, Ndao-Brumblay SK, West B, Washington T. Differences in prescription opioid analgesic availability: comparing minority and white pharmacies across Michigan. J Pain. 2005;6(10):689–99.

    Google Scholar 

  11. Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. JNCI J Natl Cancer Inst. 2002;94(7):490–6.

    Article  Google Scholar 

  12. Madison T, Schottenfeld D, James SA, Schwartz AG, Gruber SB. Endometrial cancer: socioeconomic status and racial/ethnic differences in stage at diagnosis, treatment, and survival. Am J Public Health. 2004;94:2104–11.

    Article  PubMed  Google Scholar 

  13. Cooper R, Cutler J, Desvigne-Nickens P, Fortmann SP, Friedman L, Havlik F, Hogelin G, Marler J, McGovern P, Morosco G, Mosca L, Pearson T, Stamler J, Stryer D, Thom T. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation. 2000;102:3137–47.

    Article  PubMed  CAS  Google Scholar 

  14. Meara ER, Richards S, Cutler DM. The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000. Heal Aff. 2008;27(2):350–60.

    Article  Google Scholar 

  15. Le H, Ziogas A, Lipkin SM, Zell JA. Effects of socioeconomic status and treatment disparities in colorectal cancer survival. Cancer Epidemiol Biomarkers Prev. 2008;17(8):1950–62.

    Article  PubMed  Google Scholar 

  16. Tamayo-Sarver JH, Dawson NV, Hinze SW, Cydulka RK, Wigton RS, Albert JM, Ibrahim SA, Baker DW. The effect of race/ethnicity and desirable social characteristics on physicians’ decisions to prescribe opioid analgesics. Acad Emerg Med. 2003;10(11):1239–48.

    Article  PubMed  Google Scholar 

  17. Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, Bindman AB. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334(20):1305–10.

    Article  PubMed  CAS  Google Scholar 

  18. Rabinowitz HK, Diamond JJ, Veloski JJ, Gayle JA. The impact of multiple predictors on generalist physicians’ care of underserved populations. Am J Public Health. 2000;90(8):1225–8.

    Article  PubMed  CAS  Google Scholar 

  19. Cooper LA, Powe NR. Disparities in patient experiences, health care processes, and outcomes: the role of patient-provder racial, ethnic, and language concordance. The Commonwealth Fund, July 2004.

  20. Berger JT. The influence of physicians’ demographic characteristics and their patients’ demographic characteristics on physician practice: implications for education and research. J Assoc Am Med Coll. 2008;83(1):100–5.

    Google Scholar 

  21. Sequist TD, Fitzmaurice GM, Marshall R, Marston A, Safran DG, Ayanian JZ. Cultural competency training and performance reports to improve diabetes care for black patients: a cluster randomized, controlled trial. Ann Intern Med. 2010;152:40–6.

    Article  PubMed  Google Scholar 

  22. Glymour MM, Saha S, Bigby JA. Physician race and ethnicity, professional satisfaction, and work-related stress: results from the Physician Worklife Study. Natl Med Assoc. 2004;96(10):1283–9. 1294.

    Google Scholar 

  23. U. S. Census Bureau. Per capita statistics: United States. Retrieved April 11, 2012. From http://www.census.gov/statab/ranks/rank29.html;2000.

  24. Heins A, Grammas M, Heins JK, Costello MW, Huang K, Mishra S. Determinants of variation in analgesic and opioid prescribing practice in an emergency department. J Opioid Manag. 2006;2(6):335–40.

    PubMed  Google Scholar 

  25. Dormuth CR, Miller TA, Huang A, Mamdani MM, Juurlink DN. Canadian drug safety and effectiveness research network. Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines. Can Med Assoc J. 2012;184(16):E852–6.

    Article  Google Scholar 

  26. Reifler LM, Droz D, Bailey JE, et al. Do prescription monitoring programs impact state trends in opioid abuse/misuse? Pain Manag. 2012;13:434–42.

    Article  Google Scholar 

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Financial Disclosures

None.

Conflict of Interest

The authors declare that they do not have any conflicts of interest.

Contributor’s Statement

All authors made substantial contributions to the conception and design, interpretation of data, drafting and revising of the manuscript, and final approval for publication.

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Authors and Affiliations

  1. Center for Primary Care, Culver Medical Group, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY, 14609, USA

    Michael Joynt MD, Meghan K. Train DO, Brett W. Robbins MD, Enrico Caiola MD & Robert J. Fortuna MD, MPH

  2. Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Michael Joynt MD, Meghan K. Train DO, Brett W. Robbins MD, Enrico Caiola MD & Robert J. Fortuna MD, MPH

  3. Strong Children’s Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Brett W. Robbins MD, Jill S. Halterman MD, MPH & Robert J. Fortuna MD, MPH

Authors
  1. Michael Joynt MD
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  2. Meghan K. Train DO
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  3. Brett W. Robbins MD
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  4. Jill S. Halterman MD, MPH
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  5. Enrico Caiola MD
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  6. Robert J. Fortuna MD, MPH
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Corresponding author

Correspondence to Robert J. Fortuna MD, MPH.

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Joynt, M., Train, M.K., Robbins, B.W. et al. The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States. J GEN INTERN MED 28, 1604–1610 (2013). https://doi.org/10.1007/s11606-013-2516-z

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  • DOI: https://doi.org/10.1007/s11606-013-2516-z

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