J Gen Intern Med. 2013 Dec;28(12):1604-10. doi: 10.1007/s11606-013-2516-z.
Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear.
(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.
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.
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.
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.
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.
在急诊科（ED），阿片类药物的开具存在明显的种族和民族差异，然而社会经济地位（SES）的影响仍不清楚。
（1）研究社区 SES 对中度至重度疼痛阿片类药物开具的影响；（2）确定在考虑 SES 后，阿片类药物开具的种族差异是否仍然存在。
我们使用了 2006 年至 2009 年期间全国医院门诊医疗调查的横断面数据，以检查中度至重度疼痛（1.84 亿次就诊）患者的阿片类药物开具情况。我们使用逻辑回归来检查阿片类药物开具、SES 和种族之间的关联。模型根据患者邮政编码内的收入、贫困百分比和教育水平进行了年龄、性别、疼痛程度、受伤状况、急诊就诊频率、医院类型和地区的调整。
我们的主要观察指标是在中度至重度疼痛就诊时是否开具了阿片类药物。SES 根据患者邮政编码内的收入、贫困百分比和教育水平来确定。
与 SES 最低四分位的患者相比，SES 最高四分位的患者就诊时开具阿片类药物的频率更高，包括贫困百分比（49.0% vs. 39.4%，P<0.001）、家庭收入（47.3% vs. 40.7%，P<0.001）和教育水平（46.3% vs. 42.5%，P=0.01）。在所有 SES 测量指标中，黑种人患者开具阿片类药物的频率均低于白种人患者。在调整模型中，黑种人患者（AOR 0.73；95%CI 0.66–0.81）和来自贫困地区的患者（AOR 0.76；95%CI 0.68–0.86）在考虑疼痛程度、年龄、受伤状况和其他混杂因素后，不太可能接受阿片类药物治疗。
来自 SES 较低地区的急诊科就诊患者在疼痛程度相同的情况下，接受阿片类药物治疗的可能性低于来自较富裕地区的患者。在考虑 SES 后，黑人和西班牙裔患者在疼痛程度相同的情况下接受阿片类药物治疗的可能性也低于白人患者。
