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Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.
JAMA. 2008 Jan 02; 299(1):70-8.JAMA

Abstract

CONTEXT

National quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased.

OBJECTIVES

To determine whether opioid prescribing in emergency departments has increased, whether non-Hispanic white patients are more likely to receive an opioid than other racial/ethnic groups, and whether differential prescribing by race/ethnicity has diminished since 2000.

DESIGN AND SETTING

Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes from 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey.

MAIN OUTCOME MEASURE

Prescription of an opioid analgesic.

RESULTS

Pain-related visits accounted for 156 729 of 374 891 (42%) emergency department visits. Opioid prescribing for pain-related visits increased from 23% (95% confidence interval [CI], 21%-24%) in 1993 to 37% (95% CI, 34%-39%) in 2005 (P < .001 for trend), and this trend was more pronounced in 2001-2005 (P = .02). Over all years, white patients with pain were more likely to receive an opioid (31%) than black (23%), Hispanic (24%), or Asian/other patients (28%) (P < .001 for trend), and differences did not diminish over time (P = .44), with opioid prescribing rates of 40% for white patients and 32% for all other patients in 2005. Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children. Statistical adjustment for pain severity and other factors did not substantially attenuate these differences, with white patients remaining significantly more likely to receive an opioid prescription than black patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients (0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79; 95% CI, 0.67-0.93).

CONCLUSION

Opioid prescribing for patients making a pain-related visit to the emergency department increased after national quality improvement initiatives in the late 1990s, but differences in opioid prescribing by race/ethnicity have not diminished.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94107, USA. mpletcher@epi.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18167408

Citation

Pletcher, Mark J., et al. "Trends in Opioid Prescribing By Race/ethnicity for Patients Seeking Care in US Emergency Departments." JAMA, vol. 299, no. 1, 2008, pp. 70-8.
Pletcher MJ, Kertesz SG, Kohn MA, et al. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299(1):70-8.
Pletcher, M. J., Kertesz, S. G., Kohn, M. A., & Gonzales, R. (2008). Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA, 299(1), 70-8. https://doi.org/10.1001/jama.2007.64
Pletcher MJ, et al. Trends in Opioid Prescribing By Race/ethnicity for Patients Seeking Care in US Emergency Departments. JAMA. 2008 Jan 2;299(1):70-8. PubMed PMID: 18167408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. AU - Pletcher,Mark J, AU - Kertesz,Stefan G, AU - Kohn,Michael A, AU - Gonzales,Ralph, PY - 2008/1/3/pubmed PY - 2008/1/11/medline PY - 2008/1/3/entrez SP - 70 EP - 8 JF - JAMA JO - JAMA VL - 299 IS - 1 N2 - CONTEXT: National quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased. OBJECTIVES: To determine whether opioid prescribing in emergency departments has increased, whether non-Hispanic white patients are more likely to receive an opioid than other racial/ethnic groups, and whether differential prescribing by race/ethnicity has diminished since 2000. DESIGN AND SETTING: Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes from 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey. MAIN OUTCOME MEASURE: Prescription of an opioid analgesic. RESULTS: Pain-related visits accounted for 156 729 of 374 891 (42%) emergency department visits. Opioid prescribing for pain-related visits increased from 23% (95% confidence interval [CI], 21%-24%) in 1993 to 37% (95% CI, 34%-39%) in 2005 (P < .001 for trend), and this trend was more pronounced in 2001-2005 (P = .02). Over all years, white patients with pain were more likely to receive an opioid (31%) than black (23%), Hispanic (24%), or Asian/other patients (28%) (P < .001 for trend), and differences did not diminish over time (P = .44), with opioid prescribing rates of 40% for white patients and 32% for all other patients in 2005. Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children. Statistical adjustment for pain severity and other factors did not substantially attenuate these differences, with white patients remaining significantly more likely to receive an opioid prescription than black patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients (0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79; 95% CI, 0.67-0.93). CONCLUSION: Opioid prescribing for patients making a pain-related visit to the emergency department increased after national quality improvement initiatives in the late 1990s, but differences in opioid prescribing by race/ethnicity have not diminished. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/18167408/Trends_in_opioid_prescribing_by_race/ethnicity_for_patients_seeking_care_in_US_emergency_departments_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2007.64 DB - PRIME DP - Unbound Medicine ER -