Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles.
VA Greater Los Angeles Healthcare System, Department of Veterans Affairs, Los Angeles, California.
JAMA Health Forum. 2021 Sep 10;2(9):e212333. doi: 10.1001/jamahealthforum.2021.2333. eCollection 2021 Sep.
Substantial patient racial and ethnic differences in opioid prescribing have been documented, but how much of these differences were attributable to physicians prescribing opioids differently to patients of racial and ethnic minority groups is unknown, particularly during the first wave of the opioid epidemic when the dangers of opioid prescribing and use were not as well known.
To examine associations of patient race and ethnicity with differences in opioid prescribing by the same primary care physician (PCP) for new low back pain episodes among older adults from 2007 to 2014.
This cross-sectional study used Medicare data of PCP office visits by Medicare beneficiaries who were 66 years or older with new low back pain.
Prescribing of any opioid in the first year of a new low back pain episode (days 1-365) and subsequent long-term use of an opioid (prescribed for ≥180 days in days 366-730).
Among the study population of 274 771 patients (mean [SD] age, 77.1 [7.2] years; 192 105 [69.9%] women) with new low back pain, 15 285 (6%) were Asian or Pacific Islander, 16 079 (6%) were Black, 21 289 (8%) were Hispanic, and 222 118 (81%) were White, cared for by 63 494 physicians. In adjusted analysis, on average, 11.5% of the White patients (95% CI, 11.4 to 11.6) received an opioid prescription in the first year of new low back pain. The same prescribing physician was 1.5 percentage points (PP; 95% CI, -2.2 PP to -0.8 PP) less likely to prescribe an opioid if the patient was Black, 2.7 PP (95% CI, -3.5 PP to -1.8 PP) less likely if the patient was Asian or Pacific Islander, and 1.0 PP (95% CI, -1.7 PP to -0.3 PP) less likely if the patient was Hispanic. The same physician was more likely to prescribe a prescription nonsteroidal anti-inflammatory drug to a patient of a racial or ethnic minority group. White patients with new low back pain were more likely to develop subsequent long-term opioid use than patients of racial and ethnic minority groups (eg, 1.8% for White patients vs 0.5% for Hispanic patients).
This cross-sectional study found that from 2007 to 2014, primary care physicians prescribed opioids for new low back pain more often to White patients than to patients of racial and ethnic minority groups. These results suggest that there may have been unequal treatment of pain by physicians when less was known about the morbidity associated with opioid use.
大量的患者在种族和民族方面存在显著的阿片类药物处方差异，但是这些差异中有多少是由于医生对少数民族群体的患者开具阿片类药物处方的方式不同造成的，目前还不得而知，尤其是在阿片类药物流行的第一波期间，当时人们对阿片类药物处方和使用的危害还不太了解。
本研究旨在评估 2007 年至 2014 年间，同一初级保健医生（PCP）为新出现的老年低位腰痛患者开具阿片类药物处方时，患者种族和民族差异与阿片类药物处方之间的关联。
设计、地点和参与者：本横断面研究使用了 Medicare 数据，纳入了 Medicare 受益人的 PCP 就诊信息，这些患者年龄在 66 岁及以上，患有新出现的低位腰痛。
新出现的低位腰痛发作后第一年（第 1 天至 365 天）开具任何阿片类药物处方的情况，以及随后长期使用阿片类药物的情况（第 366 天至 730 天开具处方，持续使用≥180 天）。
在研究人群中，有 274771 名患有新出现的低位腰痛的患者（平均[标准差]年龄，77.1[7.2]岁；192105[69.9%]名女性），其中 15285 名（6%）为亚裔或太平洋岛民，16079 名（6%）为黑人，21289 名（8%）为西班牙裔，222118 名（81%）为白人，他们由 63494 名医生治疗。在调整后的分析中，平均而言，11.5%的白人患者（95%CI，11.4 至 11.6）在新出现的低位腰痛的第一年接受了阿片类药物处方。如果患者是黑人，开具阿片类药物的可能性则降低 1.5 个百分点（95%CI，-2.2 个百分点至-0.8 个百分点），如果患者是亚裔或太平洋岛民，则降低 2.7 个百分点（95%CI，-3.5 个百分点至-1.8 个百分点），如果患者是西班牙裔，则降低 1.0 个百分点（95%CI，-1.7 个百分点至-0.3 个百分点）。如果患者为少数民族群体，则同一名医生开具处方非甾体抗炎药的可能性更高。患有新出现的低位腰痛的白人患者比少数民族群体的患者更有可能出现随后的长期阿片类药物使用（例如，白人患者为 1.8%，而西班牙裔患者为 0.5%）。
本横断面研究发现，2007 年至 2014 年间，初级保健医生为新出现的低位腰痛白人患者开具阿片类药物处方的频率高于少数民族群体的患者。这些结果表明，当人们对阿片类药物使用相关发病率的了解较少时，医生在治疗疼痛方面可能存在不平等现象。
