Inconsistent Pain Management Care Between Racial Groups

Abdominal pain is the reason behind 5% of emergency department visits, according to a report in American Family Physician. But analgesic pain management differs greatly between racial/ethnic groups.

“This analysis, which uses data from [emergency departments] EDs from across the country, found that minorities experience significant disparities with regard to the receipt of analgesic medications for abdominal pain,” senior author Adil Haider, MD, MPH, from Brigham and Women’s Hospital in Boston, said in a news release.

To see just how prominent these differences were, researchers examined the results from the Centers of Disease Control and Prevention’s National Hospital Ambulatory Medical Care Survey (CDC-NHAMCS). The data 6,710 ED visits from 2006 to 2010, according to the analysis published in Medical Care. All of the patients were at least 18 years old and the primary reason for the visit was non-traumatic acute abdominal pain.

• Caucasian: 61.2% or 4,106 patients
• African American: 20.1% or 1,352 patients
• Hispanic: 14% or 939 patients
• Other: 4.7% or 313 patients

The researchers looked at pain medications and adjusted for individual patient and hospital characteristics, among other factors. What they found was that there is a noticeable difference between the races when it came to who received prescriptions. Overall, minorities were 22% to 30% less likely to be prescribed analgesic medication.

• Caucasian: 57%
• African American: 51%
• Hispanic: 53%
• Other: 47%

Furthermore, Caucasians were also more likely to be prescribed narcotic analgesic drugs than African American patients — even in cases where pain levels were comparable. Minorities were 17% to 30% less likely to receive narcotics, but that wasn’t all the team found. There were also differences in wait time and admittance to the hospital.

“Black patients had the greatest increased odds of under treatment for pain among the groups considered,” Haider continued. “Black and Hispanic patients experienced prolonged ED lengths of stay and were less likely to be hospitalized for their ailment.”

Notably, the study included hospitals that served the greatest percentage of minority racial/ethnic groups, most of whom had severe pain.

“Our findings indicate that disparities in healthcare delivery continue to represent an area of important concern,” the authors concluded. “It is essential that we as a medical community work to ensure that every patient receive unbiased empathy and the highest standard of care, regardless of his/her racial heritage.”

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