University of California, Irvine, 333 City Boulevard West Suite 640, Orange, CA 92868, USA.
University of California, Irvine, 333 City Boulevard West Suite 640, Orange, CA 92868, USA; Long Beach Memorial Miller's Children Hospital, 2801 Atlantic Ave, Long Beach, CA 90806, USA.
Am J Emerg Med. 2022 Jan;51:210-213. doi: 10.1016/j.ajem.2021.10.017. Epub 2021 Oct 14.
Racial disparities have been well documented in literature regarding pain management. However, few studies have focused on its effect in the pediatric population. This study seeks to examine the relationship between race and opioid prescription patterns for children with fractures.
A retrospective study was conducted by reviewing all analgesic prescriptions of discharged pediatric patients (ages 0-21, median 10 years) from a large children's hospital over a five-year period. Multiple logistic regression analysis was applied to examine racial differences in opioid prescriptions for patients with long bone fractures after adjusting for sex, age, length of stay, and payer type.
58,402 analgesic prescriptions were reviewed in this study; 5061 were given for the primary discharge diagnosis of "fracture" of any bone. Overall, 52% of analgesics prescribed for this diagnosis were opioid medications. The relative frequency of opioid prescriptions was 48.7% in Hispanic White patients and 63.1% in non-Hispanic White patients. The odds ratio for non-Hispanic White patients to be prescribed an opioid medication was 1.44 (CI 1.20-1.73) compared to Black patients and to Hispanic White patients after adjustment for sex, age, length of hospital stay, and payer type. The same racial disparity pattern was observed in patients regardless of long bone fracture location.
Racial bias is suggested in opioid prescription patterns, even in the pediatric population, which may have untoward negative downstream effects. This study delineates the need for improved and standardized methods to adequately treat pain and reduce variations in prescriber habits.
在有关疼痛管理的文献中，种族差异得到了充分的记录。然而，很少有研究关注其在儿科人群中的影响。本研究旨在研究种族与儿童骨折患者阿片类药物处方模式之间的关系。
通过回顾一家大型儿童医院五年间出院的儿科患者（0-21 岁，中位数 10 岁）的所有镇痛处方，进行了一项回顾性研究。应用多变量逻辑回归分析，在调整性别、年龄、住院时间和支付类型后，检查长骨骨折患者阿片类药物处方的种族差异。
本研究共审查了 58402 份镇痛处方；5061 份用于“骨折”的主要出院诊断，任何骨骼。总体而言，48.7%的阿片类药物处方用于该诊断。西班牙裔白种人和非西班牙裔白种人分别有 48.7%和 63.1%的患者处方阿片类药物。与黑人和西班牙裔白人患者相比，非西班牙裔白人患者被开阿片类药物的几率比为 1.44（CI 1.20-1.73），调整性别、年龄、住院时间和支付类型后。在无论长骨骨折位置如何的患者中，都观察到了相同的种族差异模式。
即使在儿科人群中，阿片类药物处方模式也存在种族偏见，这可能会产生不利的下游影响。本研究阐明了需要改进和标准化方法来充分治疗疼痛并减少处方者习惯的差异。
