Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System (152), Iowa City, IA 52246, USA.
Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA 52246, USA.
Mil Med. 2023 Nov 3;188(11-12):3599-3605. doi: 10.1093/milmed/usac152.
African Americans (AAs) experience disparities in chronic pain care. This study aimed to identify the rates of emergency department (ED) utilization for visits associated with chronic pain diagnoses among AAs compared to Whites and to determine variables that accounted for any differences.
This retrospective observational study used national Veterans Affairs (Veteran's Health Administration) administrative data to identify Veterans with chronic pain diagnoses in 2018. Race/ethnicity was self-reported and assessed to examine if differences exist in ED utilization. Differences between AAs and Whites were examined using negative binomial regression models, controlling for ethnicity. Multivariable models (including demographics, pain characteristics, psychiatric comorbidities, medical comorbidities, pain-related health care utilization, and medication utilization) were examined to determine factors that contributed to these disparities.
Among the 2,261,030 patients, 22% (n = 492,138) were AA. The incidence rate ratio of ED utilization for AAs, relative to Whites, was 1.58 (95% CI: 1.56-1.59). The only independent variable that produced a clinically meaningful reduction in the race effect on ED use was rurality, which was associated with reduced ED use. Post hoc model including all variables reduced the race effect to 1.37 (95% CI: 1.36-1.38).
AA Veterans had a 58% greater risk of ED utilization for visits associated with chronic pain diagnoses relative to White Veterans, which remained meaningfully elevated after adjustment for observable confounders (37%). This observation may reflect disparities in outpatient chronic pain care for AAs. Future research could focus on enhancing therapeutic alliance in primary care to improve chronic pain treatment for AAs.
非裔美国人（AAs）在慢性疼痛护理方面存在差异。本研究旨在确定与慢性疼痛诊断相关的就诊中急诊部（ED）利用率在 AAs 与白人之间的差异，并确定导致这些差异的变量。
本回顾性观察性研究使用全国退伍军人事务部（退伍军人健康管理局）的行政数据，于 2018 年确定患有慢性疼痛诊断的退伍军人。种族/民族是自我报告的，并进行评估以检查 ED 利用率是否存在差异。使用负二项式回归模型检查 AAs 与白人之间的差异，同时控制种族。多变量模型（包括人口统计学、疼痛特征、精神共病、医疗共病、与疼痛相关的医疗保健利用和药物利用）用于确定导致这些差异的因素。
在 2261030 名患者中，22%（n=492138）为 AA。与白人相比，AAs 的 ED 利用率的发病率比为 1.58（95%CI：1.56-1.59）。唯一产生 ED 使用种族效应临床有意义降低的独立变量是农村地区，农村地区与 ED 使用减少相关。包括所有变量的事后模型将种族效应降低到 1.37（95%CI：1.36-1.38）。
与白人退伍军人相比，AA 退伍军人因与慢性疼痛诊断相关的就诊而前往 ED 的风险增加了 58%，这一风险在调整可观察混杂因素后仍显著升高（37%）。这一观察结果可能反映了 AAs 在慢性疼痛门诊护理方面的差异。未来的研究可以集中在增强初级保健中的治疗联盟，以改善 AAs 的慢性疼痛治疗。
