School of Nursing and the Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
RAND Corporation, Santa Monica, California, USA.
Inj Prev. 2024 Jan 25;30(1):14-19. doi: 10.1136/ip-2023-044876.
Chronic pain represents a substantial health burden and source of disability following traumatic injury. This study investigates factors associated with racial and ethnic disparities in chronic pain.
Prospective, longitudinal, panel study. Seriously injured patients were recruited from two trauma centres in the Northeastern and Southwestern USA. Data from medical records and individual surveys were collected in-hospital, and at 3-month and 12-month postinjury from a balanced cohort of non-Hispanic black, non-Hispanic white and Hispanic patients. We used linear regression to estimate the associations between race and ethnicity and 3-month and 12-month pain severity outcomes. We grouped all available cohort data on factors that theoretically influence the emergence of chronic pain after injury into five temporally ordered clusters and entered each cluster sequentially into regression models. These included: participant race and ethnicity, other demographic characteristics, preinjury health characteristics, acute injury characteristics and postinjury treatment.
650 participants enrolled (Hispanic 25.6%; white 38.1%; black 33.4%). Black participants reported highest relative chronic pain severity. Injury-related factors at the time of acute hospitalisation (injury severity, mechanism, baseline pain and length of stay) were most strongly associated with racial and ethnic disparities in chronic pain outcomes. After controlling for all available explanatory factors, a substantial proportion of the racial and ethnic disparities in chronic pain outcomes remained.
Racial and ethnic disparities in chronic pain outcomes may be most influenced by differences in the characteristics of acute injuries, when compared with demographic characteristics and postacute treatment in the year after hospitalisation.
慢性疼痛是创伤后造成健康负担和残疾的主要原因。本研究调查了与慢性疼痛的种族和民族差异相关的因素。
前瞻性、纵向、面板研究。从美国东北部和西南部的两家创伤中心招募了严重受伤的患者。从非西班牙裔黑人、非西班牙裔白人和西班牙裔患者的均衡队列中，在住院期间以及受伤后 3 个月和 12 个月，从病历和个人调查中收集数据。我们使用线性回归来估计种族和民族与 3 个月和 12 个月疼痛严重程度结果之间的关联。我们将理论上影响受伤后慢性疼痛出现的所有可用队列数据因素分为五个时间顺序的集群，并将每个集群依次输入回归模型。这些因素包括：参与者的种族和民族、其他人口统计学特征、受伤前的健康特征、急性损伤特征和受伤后的治疗。
共纳入 650 名参与者（西班牙裔 25.6%；白人 38.1%；黑人 33.4%）。黑人参与者报告的慢性疼痛相对严重程度最高。急性住院期间与损伤相关的因素（损伤严重程度、机制、基线疼痛和住院时间）与慢性疼痛结果的种族和民族差异最相关。在控制所有可用的解释因素后，慢性疼痛结果的种族和民族差异仍有相当大的一部分。
与住院后 1 年内的人口统计学特征和急性后治疗相比，慢性疼痛结果的种族和民族差异可能受急性损伤特征的差异影响最大。
