School of Medicine and Health Sciences Poster Presentations

Title

Racial and Ethnic Disparities in the Management of Acute Pain in US Emergency Departments: Meta-Analysis and Systematic Review

Document Type

Poster

Abstract Category

Clinical Specialties

Keywords

Minorities, ethnicity, acute pain, analgesia, pain management, acute services

Publication Date

Spring 5-1-2019

Abstract

Background: Prior evidence suggests that healthcare disparities exist in a variety of healthcare settings and for multiple medical conditions. For patients with acute pain, there is conflicting data about the existence of racial/ethnic disparities in the ED management of acute pain. This review aims to quantify the effect of minority status on receipt of analgesia for acute pain management in US Emergency Departments and urgent care settings. Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to perform a systematic review and meta-analysis of articles from 1990 to 2018 that compared racial/ethnic differences in the administration of analgesia for acute pain in EDs. Inclusion criteria include research conducted between 1990 and 2018, US-based ED or urgent care settings, adult patients, and studies that compared white patients to an ethnic or racial minority for acute pain. Exclusion criteria included research that focused primarily on chronic pain, chest pain, post-operative pain, case reports or survey studies. Acute pain was categorized by traumatic or non-traumatic causes and analgesia was categorized by opiate or non-opiate class. Two independent reviewers were involved in each stage of review. Following data abstraction, meta-analysis was performed using a fixed effects and random-effects model to determine primary outcome of analgesia administration stratified by racial and ethnic classification. Results: 763 articles were screened for eligibility and ultimately fourteen studies met inclusion criteria. Thirteen studies compared black and white patients and seven compared Hispanic and non-Hispanic patients. In total, study population included 7070 non-Hispanic white patients, 1538 Hispanic patients, 3125 black patients and population was 50.3% Female. Black patients were less likely than white to receive analgesia medication for acute pain: OR 0.64 [95%-CI: 0.55-0.75, fixed effects model] and OR 0.60 [95%-CI, 0.43-0.83, random effects model]. Hispanics were also less likely to receive analgesia administration in the ED: OR 0. 70 [95%-CI, 0.57-0.87, fixed effects model] and 0.75 [95%-CI, 0.52-1.09, random effects model]. Conclusion: This meta-analysis demonstrates the presence of racial/ethnic disparities in analgesic administration for the management of acute pain in US EDs. Further research is needed to examine patient reported outcomes in addition to the presence of racial/ethnic disparities in other racial groups. Trial registration: Registration number CRD42018104697 in PROSPERO.

Open Access

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Comments

Presented at Research Days 2019.

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Racial and Ethnic Disparities in the Management of Acute Pain in US Emergency Departments: Meta-Analysis and Systematic Review

Background: Prior evidence suggests that healthcare disparities exist in a variety of healthcare settings and for multiple medical conditions. For patients with acute pain, there is conflicting data about the existence of racial/ethnic disparities in the ED management of acute pain. This review aims to quantify the effect of minority status on receipt of analgesia for acute pain management in US Emergency Departments and urgent care settings. Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to perform a systematic review and meta-analysis of articles from 1990 to 2018 that compared racial/ethnic differences in the administration of analgesia for acute pain in EDs. Inclusion criteria include research conducted between 1990 and 2018, US-based ED or urgent care settings, adult patients, and studies that compared white patients to an ethnic or racial minority for acute pain. Exclusion criteria included research that focused primarily on chronic pain, chest pain, post-operative pain, case reports or survey studies. Acute pain was categorized by traumatic or non-traumatic causes and analgesia was categorized by opiate or non-opiate class. Two independent reviewers were involved in each stage of review. Following data abstraction, meta-analysis was performed using a fixed effects and random-effects model to determine primary outcome of analgesia administration stratified by racial and ethnic classification. Results: 763 articles were screened for eligibility and ultimately fourteen studies met inclusion criteria. Thirteen studies compared black and white patients and seven compared Hispanic and non-Hispanic patients. In total, study population included 7070 non-Hispanic white patients, 1538 Hispanic patients, 3125 black patients and population was 50.3% Female. Black patients were less likely than white to receive analgesia medication for acute pain: OR 0.64 [95%-CI: 0.55-0.75, fixed effects model] and OR 0.60 [95%-CI, 0.43-0.83, random effects model]. Hispanics were also less likely to receive analgesia administration in the ED: OR 0. 70 [95%-CI, 0.57-0.87, fixed effects model] and 0.75 [95%-CI, 0.52-1.09, random effects model]. Conclusion: This meta-analysis demonstrates the presence of racial/ethnic disparities in analgesic administration for the management of acute pain in US EDs. Further research is needed to examine patient reported outcomes in addition to the presence of racial/ethnic disparities in other racial groups. Trial registration: Registration number CRD42018104697 in PROSPERO.