Dataset Information

Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015.

ABSTRACT:

Background

In the United States whites are more likely to misuse opioid pain relievers (OPRs) than blacks, and blacks are less likely to be prescribed OPRs than whites. Our objective is to determine whether racial discrimination in medical settings is protective for blacks against OPR misuse, thus mediating the black-white disparities in OPR misuse.

Methods

We used data from 3528 black and white adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, an ongoing multi-site cohort. We employ causal mediation methods, with race (black vs white) as the exposure, lifetime discrimination in medical settings prior to year 2000 as the mediator, and OPR misuse after 2000 as the outcome.

Results

We found black participants were more likely to report discrimination in a medical setting (20.3% vs 0.9%) and less likely to report OPR misuse (5.8% vs 8.0%, OR = 0.71, 95% CI = 0.55, 0.93, adjusted for covariates). Our mediation models suggest that when everyone is not discriminated against, the disparity is wider with black persons having even lower odds of reporting OPR misuse (OR = 0.63, 95% CI = 0.45, 0.89) compared to their white counterparts, suggesting racial discrimination in medical settings is a risk factor for OPR misuse rather than protective.

Conclusions

These results suggest that racial discrimination in a medical setting is a risk factor for OPR misuse rather than being protective, and thus could not explain the seen black-white disparity in OPR misuse.

SUBMITTER: Swift SL

PROVIDER: S-EPMC6924655 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015.

Swift Samuel L SL Glymour M Maria MM Elfassy Tali T Lewis Cora C Kiefe Catarina I CI Sidney Stephen S Calonico Sebastian S Feaster Daniel D Bailey Zinzi Z Zeki Al Hazzouri Adina A

PloS one 20191220 12

<h4>Background</h4>In the United States whites are more likely to misuse opioid pain relievers (OPRs) than blacks, and blacks are less likely to be prescribed OPRs than whites. Our objective is to determine whether racial discrimination in medical settings is protective for blacks against OPR misuse, thus mediating the black-white disparities in OPR misuse.<h4>Methods</h4>We used data from 3528 black and white adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, an ongo ...[more]

PMID: 31860661

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Project description:Introduction:We assess trends in opioid administration and prescribing from 2005-2015 in older adults in United States (U.S.) emergency departments (ED). Methods:We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18-64, 65-74, 75-84, ? 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ? 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored. Results:Opioid administration in the ED and prescribing at discharge for encounters with patients ? 65 years fell overall, but not significantly. By contrast, opioid administration in the ED and prescribing at discharge significantly declined for adult encounters 18-64 by 20% and 32%, respectively. A similar proportion of adult encounters ? 65 were administered opioids in the ED as 18-64, but adult encounters ? 85 had the lowest rates of administration. A smaller proportion of adult encounters ? 65 years with painful conditions were prescribed opioids at discharge compared to <65. However, this age-related disparity in prescribing narrowed over the study period. There were shifts in the specific types of opioids administered and prescribed in adult encounters ? 65 years over the study period, with the most notable being a 76% increase in hydromorphone administration comparing 2005-06 to 2014-15. Conclusion:From 2005-15, 1 in 4 to 1 in 10 ED patients with painful conditions were administered or prescribed an opioid in U.S. EDs. Opioids prescribing increased from 2005-11 and then declined from 2012-15, more so among visits in the 18-64 age group compared to ? 65 years. Opioid administrating demonstrated a gradual rise and decline in all adult age groups. Age consistently appears to be an important consideration, where opioid prescribing declines with advancing age. Given the nationwide opioid crisis, ED providers should remain vigilant in limiting opioids, particularly in older adults who are at higher risk for adverse effects.

Dataset Information

Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015.

Background

Methods

Results

Conclusions

Publications

Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015.

Similar Datasets

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