University of California, Davis School of Medicine, Department of Emergency Medicine, Davis, California.
David Grant Medical Center, Travis Air Force Base, Fairfield, California.
West J Emerg Med. 2022 Oct 24;23(6):826-831. doi: 10.5811/westjem.2022.8.55750.
Racial disparities in pain management have been reported among emergency department (ED) patients. In this study we evaluated the association between patients' self-identified race/ethnicity and the administration of opioid analgesia among ED patients with abdominal pain, the most common chief complaint for ED presentations in the United States.
This was a retrospective cohort study of adult (age ≥18 years) patients who presented to the ED of a single center with abdominal pain from January 1, 2019-December 31, 2020. We collected demographic and clinical information, including patients' race and ethnicity, from the electronic health record. The primary outcome was the ED administration of any opioid analgesic (binary). Secondary outcomes included the administration of non-opioid analgesia (binary) and administration of any analgesia (binary). We used logistic regression models to estimate odds ratios (OR) of the association between a patient's race/ethnicity and analgesia administration. Covariates included age, sex, initial pain score, Emergency Severity Index, and ED visits in the prior 30 days. Subgroup analyses were performed in non-pregnant patients, those who underwent any imaging study, were admitted to the hospital, and who underwent surgery within 24 hours of ED arrival.
We studied 7,367 patients: 45% (3,314) were non-Hispanic (NH) White; 28% (2,092) were Hispanic/Latinx; 19% (1,384) were NH Black, and 8% (577) were Asian. Overall, 44% (3,207) of patients received opioid analgesia. In multivariable regression models, non-White patients were less likely to receive opioid analgesia compared with White patients (OR 0.73, 95% CI 0.65-0.83 for Hispanic/Latinx patients; OR 0.62, 95% CI 0.54-0.72 for Black patients; and OR 0.64, 95% CI 0.52-0.78 for Asian patients). Black patients were also less likely to receive non-opioid analgesia, and Black and Hispanic/Latinx patients were less likely than White patients to receive any analgesia. The associations were similar across subgroups; however, the association was attenuated among patients who underwent surgery within 24 hours of ED arrival.
Hispanic/Latinx, Black, and Asian patients were significantly less likely to receive opioid analgesia than White patients when presenting to the ED with abdominal pain. Black patients were also less likely than White patients to receive non-opioid analgesia.
在急诊科（ED）患者中，已报道存在疼痛管理方面的种族差异。在这项研究中，我们评估了 ED 腹痛患者（美国 ED 就诊的最常见主诉）自我认定的种族/民族与阿片类镇痛药管理之间的关联。
这是一项回顾性队列研究，纳入了 2019 年 1 月 1 日至 2020 年 12 月 31 日期间在单一中心因腹痛就诊的年龄≥18 岁的成年（成人）患者。我们从电子健康记录中收集了人口统计学和临床信息，包括患者的种族和民族。主要结局是 ED 给予任何阿片类镇痛药（二分类）。次要结局包括给予非阿片类镇痛药（二分类）和给予任何镇痛药（二分类）。我们使用逻辑回归模型来估计患者种族/民族与镇痛管理之间关联的比值比（OR）。协变量包括年龄、性别、初始疼痛评分、紧急严重程度指数和 ED 就诊前 30 天内的就诊次数。在非妊娠患者、接受任何影像学检查、住院和在 ED 就诊后 24 小时内接受手术的患者中进行了亚组分析。
我们研究了 7367 名患者：45%（3314 名）为非西班牙裔（NH）白人；28%（2092 名）为西班牙裔/拉丁裔；19%（1384 名）为 NH 黑人，8%（577 名）为亚洲人。总体而言，44%（3207 名）的患者接受了阿片类镇痛药。在多变量回归模型中，与白人患者相比，非白人患者接受阿片类镇痛药的可能性较低（西班牙裔/拉丁裔患者的 OR 为 0.73，95%CI 为 0.65-0.83；黑人患者的 OR 为 0.62，95%CI 为 0.54-0.72；亚洲患者的 OR 为 0.64，95%CI 为 0.52-0.78）。黑人患者也较少接受非阿片类镇痛药，而黑人患者和西班牙裔/拉丁裔患者接受任何镇痛药的可能性也低于白人患者。这些关联在各亚组中相似；然而，在 ED 就诊后 24 小时内接受手术的患者中，这种关联减弱了。
与白人患者相比，西班牙裔/拉丁裔、黑人患者和亚洲患者在 ED 就诊时接受阿片类镇痛药的可能性显著降低。黑人患者接受非阿片类镇痛药的可能性也低于白人患者。
