Racial, ethnic disparities present in post-cesarean pain management
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In a retrospective cohort study, non-English speaking patients received fewer pain assessments and fewer doses of NSAIDs and oxycodone therapeutic equivalents after a cesarean delivery, according to researchers.
The results also showed that non-Hispanic Black patients received fewer NSAID doses than white patients postpartum.
“I think that our study adds to the current body of evidence that suggests that pain is assessed and treated differently based on race and ethnicity,” Alison Wiles, MD, a resident at Mount Sinai South Nassau hospital in Oceanside, New York, told Healio Primary Care. “Our results highlighted language-related health care disparities, which is likely multifactorial and requires further investigation.”
Wiles and colleagues analyzed data on 327 women (mean age, 31.8 years) who had a cesarean delivery between January 2018 and June 2018 at Mount Sinai South Nassau hospital. Among them, 125 were Hispanic, 111 were non-Hispanic white, 32 were non-Hispanic Black and 59 were Asian or another race. The analysis excluded women who had a cesarean hysterectomy, received general anesthesia or pain control via a patient-controlled analgesia pump, had opiate allergies or a history of substance use.
The researchers gathered demographic information along with data on pain assessments, severe pain scores and NSAID and oxycodone therapeutic equivalent use.
Wiles and colleagues said they did not find a difference in pain scores above seven between racial and ethnic groups or by primary language, but the data revealed significant differences in NSAID and oxycodone therapeutic equivalent doses between 0 to 24 hours postpartum as well as 24 to 48 hours postpartum.
Patients whose primary language was Spanish or another language received a mean of one NSAID dose (95% CI, 0-2) within 0 to 24 hours postpartum vs. two doses (95% CI, 0-4) among those who spoke English as primary language, according to the researchers.
From 24 to 48 hours postpartum, non-Hispanic Black patients received a mean of one NSAID dose (95% CI, 1-2), while white patients received a mean of three doses (95% CI, 1-4).
There were fewer oxycodone therapeutic equivalent doses among Hispanic patients between 24 to 48 hours postpartum. They had a mean of two doses (95% CI, 0-6) vs. four doses (95% CI, 1-4) among white patients. In addition, patients whose primary language was Spanish or another language received a mean of two oxycodone therapeutic equivalent doses (95% CI, 0-6) 24 to 48 hours postpartum, while those who spoke English as the primary language received a mean of four doses (95% CI, 1-7). Oxycodone therapeutic equivalent doses during this time period were highest among non-Hispanic Black patients, who received a mean of five doses (95% CI, 3-8).
Furthermore, patients whose primary language was Spanish or another language received fewer pain assessments (10; 95% 6-12) vs. patients whose primary language was English (11; 95% CI, 7-16).
To address these disparities, Wiles said “we should look to both individual and institutional factors.” One potential strategy is to improve translator services, which often “rely on technology that can be spotty and time-consuming,” Wiles said.
Other strategies include “hiring and training a workforce that is more reflective of the patient population for which they are providing care,” as well as “empowering non-English speakers to accurately report their pain levels using language-independent systems,” she said.
For clinicians, “in terms of incorporation of these findings into clinical practice, it is essential that physicians understand disparities, not just among race and ethnicity, but also in regard to primary language,” Wiles said. “We must acknowledge our own belief systems regarding pain control and develop strategies to overcome negative stereotyping of minority patients.”