Analysis of opioid prescribing patterns reveals racial disparities

Key takeaways:

• Black patients received from 3 to 4.7 fewer mg of oxycodone per day vs. white patients in the 90 days post-discharge.
• These disparities could ultimately result in undertreatment of pain, the researchers said.

Older Black and Asian patients received significantly lower doses of opioids following hip fracture hospitalization compared with white patients, a retrospective analysis of Medicare beneficiaries showed.

Racial disparities within pain medication prescribing are present in the health care system, particularly when comparing Black and white patients, according to Kaleen N. Hayes, PharmD, PhD, an assistant professor at Brown University, and colleagues.

However, racial differences in pain management following a hip fracture have yet to be assessed, “particularly during the critical period of transitioning back to the community and resuming normal activities of daily living,” They wrote

In the study —published in the Journal of the American Geriatrics Society — the researchers examined Medicare patient claims data from 2012 to 2018. The study cohort included 164,170 adults aged 65 years and older who were hospitalized for hip fracture to determine racial differences in those who received opioids and the prescribed doses within the first 90 days after being discharged from the hospital and back into a community setting.

They stratified beneficiaries by whether they had received institutional post-acute care, and examined opioid doses among several other diverse groups as part of the study’s secondary outcomes.

Study investigators reported similar overall opioid use between Black and white beneficiaries. However, compared with white beneficiaries, Black beneficiaries received around 165 to 167 fewer cumulative milligram morphine equivalents (MMEs) and 3 to 4.7 fewer mg of oxycodone per day over their first 90 days following their discharge.

Overall, Black beneficiaries received around 1,365 to 1,538 cumulative mg oxycodone equivalent vs. 1,616 to 1,785 cumulative mg oxycodone equivalent among white beneficiaries during the study period.

These differences “may ultimately result in undertreatment of pain in Black beneficiaries relative to their white beneficiaries,” Hayes and colleagues wrote.

Asian beneficiaries experienced even greater disparities when compared with white beneficiaries, receiving 411 to 435 fewer MMEs during the first 90 days post-discharge and 617 to 653 fewer mg of oxycodone.

The researchers suggested the differences in treatment observed are because of true disparities in pain management “that are rooted in the structural racism of the U.S. health system.”

Undertreatment of hip fracture-related pain in Black patients is a “critical issue ... as these patients already experience numerous other disparities in hip fracture care while in-hospital, including delays in time to surgery and increased risks of surgical complications and reoperations,” they wrote.

Hayes and colleagues identified multiple study limitations. The most significant included the inability to assess the reasons driving the differences in opioid prescribing between the groups, whereas hip fracture care for diverse groups may have changed in the post-COVID-19 pandemic years.

The researchers concluded that future research is warranted “[to] examine whether these differences result in disparities in short-term outcomes during the transition-of-care period after hip fracture and long-term health outcomes.”