Smith Michael A, Knecht Teresa P E, Irwin Madison N, Marshall Vincent D, Lynn Henry N, Farris Karen B
University of Michigan College of Pharmacy, Ann Arbor, MI, United States; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, United States.
University of Michigan College of Pharmacy, Ann Arbor, MI, United States.
J Pain. 2025 Jul 8;34:105490. doi: 10.1016/j.jpain.2025.105490.
Disparities in care and management of pain among racial groups have been demonstrated in various studies. Chronic overlapping pain conditions (COPCs) have yet to be examined. This was an observational cohort study of Medicare beneficiaries from 2018-2020 analyzing COPC diagnosis rates and prescription claims. Nationally representative 20% sample of Medicare beneficiaries from 2018-2020. Medicare beneficiaries ≥ 66 years of age in 2019 were included if they had ≥ nine months of A/B/D coverage in 2018-2020. Beneficiaries were excluded if they had Medicare Advantage or end-stage renal disease. Prevalence of COPC diagnosis using validated ICD-10 codes in Medicare beneficiaries and disparities in diagnosis and management. In 2019, 2,573,165 patients were included in the analysis; 87% were White, 8% Black, and 1.7% Asian. COPC diagnosis prevalence in Medicare beneficiaries was more than 10% (n=273,996). Black (odds ratio [OR], 0.89 [95% CI, 0.88-0.91]) and Asian (OR, 0.68 [95% CI, 0.66-0.71]) patients were less likely to have a COPC diagnosis. The incidence of a new COPC diagnosis was 11.4% (n=31,281) among Medicare beneficiaries; only 24.1% (n=7541) received COPC-targeted prescriptions. Black (OR, 1.13 [95% CI, 1.02-1.26]), and Asian (OR, 1.32 [95% CI, 1.06-1.63]) beneficiaries were more likely to receive COPC-targeted prescriptions. Black (OR, 1.12 [95% CI, 1.01-1.25]) beneficiaries were more likely to receive opioids. Examination of associations, not causations or reasons underlying the identified disparities. The prevalence of COPC diagnosis in Medicare beneficiaries was 10%, but only one-quarter of those received COPC-targeted prescriptions. Disparities in COPCs persist into COPCs for Black beneficiaries. PERSPECTIVE: The study examines the prevalence and management of COPCs in older adults using Medicare data. It found racial disparities in diagnosis and prescriptions, with Black and Asian beneficiaries less likely to receive a diagnosis. Opioid use remains high despite known ineffectiveness, highlighting the need for better pain management strategies.
多项研究表明，不同种族群体在疼痛护理和管理方面存在差异。慢性重叠疼痛病症（COPCs）尚未得到研究。这是一项对2018 - 2020年医疗保险受益人的观察性队列研究，分析了COPC诊断率和处方申请情况。采用2018 - 2020年全国代表性的20%医疗保险受益人样本。纳入2019年年龄≥66岁且在2018 - 2020年有≥9个月A/B/D类保险覆盖的医疗保险受益人。若受益人参加了医疗保险优势计划或患有终末期肾病，则将其排除。使用经过验证的ICD - 10编码分析医疗保险受益人中COPC诊断的患病率以及诊断和管理方面的差异。2019年，2573165名患者纳入分析；其中87%为白人，8%为黑人，1.7%为亚洲人。医疗保险受益人中COPC诊断患病率超过10%（n = 273996）。黑人（优势比[OR]，0.89[95%置信区间，0.88 - 0.91]）和亚洲人（OR，0.68[95%置信区间，0.66 - 0.71]）患者被诊断为COPC的可能性较小。医疗保险受益人中新发COPC诊断的发生率为11.4%（n = 31281）；只有24.1%（n = 7541）的患者接受了针对COPC的处方。黑人（OR，1.13[95%置信区间，1.02 - 1.26]）和亚洲人（OR，1.32[95%置信区间，1.06 - 1.63]）受益人更有可能接受针对COPC的处方。黑人（OR，1.12[95%置信区间，1.01 - 1.25]）受益人更有可能接受阿片类药物治疗。本研究考察了相关性，而非已发现差异背后的因果关系或原因。医疗保险受益人中COPC诊断的患病率为10%，但只有四分之一的患者接受了针对COPC的处方。黑人受益人的COPC差异持续存在。观点：该研究利用医疗保险数据考察了老年人中COPC的患病率和管理情况。研究发现诊断和处方方面存在种族差异，黑人和亚洲受益人被诊断的可能性较小。尽管已知阿片类药物无效，但使用量仍然很高，这凸显了需要更好的疼痛管理策略。
