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Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination

Shah, Adil A. MD*,†; Zogg, Cheryl K. MSPH, MHS*; Zafar, Syed Nabeel MBBS, MPH; Schneider, Eric B. PhD*; Cooper, Lisa A. MD, MPH§; Chapital, Alyssa B. MD, PhD; Peterson, Susan M. MD; Havens, Joaquim M. MD*; Thorpe, Roland J. Jr PhD#,¶; Roter, Debra L. DrPH, MPH**; Castillo, Renan C. PhD**; Salim, Ali MD*; Haider, Adil H. MD, MPH, FACS*

doi: 10.1097/MLR.0000000000000444
Original Articles

Background: Prior studies of acute abdominal pain provide conflicting data regarding the presence of racial/ethnic disparities in the emergency department (ED).

Objective: To evaluate race/ethnicity-based differences in ED analgesic pain management among a national sample of adult patients with acute abdominal pain based on a uniform definition.

Research Design/Subjects/Measures: The 2006–2010 CDC-NHAMCS data were retrospectively queried for patients 18 years and above presenting with a primary diagnosis of nontraumatic acute abdominal pain as defined by the American Association for the Surgery of Trauma. Independent predictors of analgesic/narcotic-specific analgesic receipt were determined. Risk-adjusted multivariable analyses were then performed to determine associations between race/ethnicity and analgesic receipt. Stratified analyses considered risk-adjusted differences by the level of patient-reported pain on presentation. Secondary outcomes included: prolonged ED-LOS (>6 h), ED wait time, number of diagnostic tests, and subsequent inpatient admission.

Results: A total of 6710 ED visits were included: 61.2% (n=4106) non-Hispanic white, 20.1% (n=1352) non-Hispanic black, 14.0% (n=939) Hispanic, and 4.7% (n=313) other racial/ethnic group patients. Relative to non-Hispanic white patients, non-Hispanic black patients and patients of other races/ethnicities had 22%–30% lower risk-adjusted odds of analgesic receipt [OR (95% CI)=0.78 (0.67–0.90); 0.70 (0.56–0.88)]. They had 17%–30% lower risk-adjusted odds of narcotic analgesic receipt (P<0.05). Associations persisted for patients with moderate-severe pain but were insignificant for mild pain presentations. When stratified by the proportion of minority patients treated and the proportion of patients reporting severe pain, discrepancies in analgesic receipt were concentrated in hospitals treating the largest percentages of both.

Conclusions: Analysis of 5 years of CDC-NHAMCS data corroborates the presence of racial/ethnic disparities in ED management of pain on a national scale. On the basis of a uniform definition, the results establish the need for concerted quality-improvement efforts to ensure that all patients, regardless of race/ethnicity, receive optimal access to pain relief.

*Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health and the Department of Surgery, Brigham & Women’s Hospital, Boston, MA

Division of General Surgery, Mayo Clinic, Phoenix, AZ

Department of Surgery, Howard University Hospital, Washington, DC

§Division of General Internal Medicine

Department of Emergency Medicine, The Johns Hopkins University School of Medicine

The Johns Hopkins Center on Aging and Health

Departments of #Health, Behavior, and Society

**Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

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Presented at the 2015, 28th Eastern Association for the Surgery of Trauma (EAST) Annual Scientific Assembly, Lake Buena Vista, FL.

A.H.H. is the primary investigator of a contract from the Patient-Centered Outcomes Research Institute (PCORI) entitled “Patient Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department” and of a Harvard Surgery Research Collaborative (ARC) Program Grant entitled “Mitigating Disparities Through Enhancing Surgeons’ Ability to Provide Culturally Relevant Care.” He is a cofounder and equity shareholder of the company Doctor Patient Technologies which runs the Web site http://www.doctella.com.

The authors declare no conflict of interest.

Reprints: Adil H. Haider, MD, MPH, FACS, Center for Surgery and Public Health, Brigham and Women’s Hospital, 1620 Tremont Street, One Brigham Circle, 4th Floor, Suite 4-020, Boston, MA 02120. E-mail: ahhaider@partners.org.

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