Associations of Race and Ethnicity With Patient-Reported Outcomes and Health Care Utilization Among Older Adults Initiating a New Episode of Care for Back Pain

Milani, Carlo; Rundell, Sean D.; Jarvik, Jeffrey G.; Friedly, Janna; Heagerty, Patrick J.; Avins, Andy; Nerenz, David R.; Gold, Laura S.; Turner, Judith A.; Annaswamy, Thiru M.; Nedeljković, Srdjan S.; Suri, Pradeep

doi:10.1097/brs.0000000000002499

Cited by 19 publications

(24 citation statements)

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“…Racial differences in chronic pain prevalence and burden of the pain exist, in that Black individuals are disproportionately affected [20][21][22][23][24]. This racial group has higher rates of most chronic pain conditions, but also report more severe and intense pain compared to their White counterparts [106].…”

Section: Discussionmentioning

confidence: 99%

“…Early medical research failed to include Black individuals in experiments [18], and it was not until the shift in civil rights that racial differences in pain were first documented by Chapman and Jones in 1944 [19]. Since that time, racial disparities have been documented in many works, revealing that Black individuals disproportionately carry the burden of chronic pain in comparison to their non-Hispanic White (White) counterparts [20][21][22][23][24]. Although the underlying mechanisms for the disparity are unclear, the fact that clinical pain is more prevalent in the Black population is well beyond doubt.…”

Section: Introductionmentioning

confidence: 99%

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Racial Differences in Pain, Nutrition, and Oxidative Stress

Strath

Sorge

2022

Pain Ther

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Investigating the disproportionate rates of chronic pain and their related comorbidities between Black and non-Hispanic White (White) individuals is a growing area of interest, both in the healthcare community and in general society. Researchers have identified racial differences in chronic pain prevalence and severity, but still very little is known about the mechanisms underlying them. Current explanations for these differences have primarily focused on socioeconomic status and unequal healthcare between races as causal factors. Whereas these factors are informative, a racial gap still exists between Black and White individuals when these factors are controlled for. One potential cause of this racial gap in chronic pain is the differences in nutrition and dietary intake between groups. Certain foods play a key role in the inflammatory and oxidative stress pathways in the human body and could potentially influence the severity of the pain experience. Here, we review the previous literature on the surrounding topics and propose a potential mechanism to explain racial differences in the chronic pain population, based on established racial differences in diet and oxidative stress.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Racial Differences in Pain, Nutrition, and Oxidative Stress

Strath

Sorge

2022

Pain Ther

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“…Prior studies have shown differences in outcomes contributed by social factors, including race and socioeconomic status (SES), with the disease burden of cLBP [ 36 , 37 ]. In the present study, there may be an association between patients with lower PH and MH scores and low SES.…”

Section: Discussionmentioning

confidence: 99%

Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study

Pak

Miller

Cheuy

2021

J Patient Rep Outcomes

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Background Although evidence-based guidelines for physical therapy for patients with chronic low back pain (cLBP) are available, selecting patient-reported outcome measures to capture complexity of health status and quality of life remains a challenge. PROMIS-10 Global Health (GH) may be used to screen for impactful health risks and enable patient-centered care. The purpose of this study was to investigate the interrelationships between PROMIS-10 GH scores and patient demographics, health status, and healthcare utilization in patients with cLBP who received physical therapy. Methods A retrospective review of de-identified electronic health records of patients with cLBP was performed. Data were collected for 328 patients seen from 2017 to 2020 in three physical therapy clinics. Patients were grouped into HIGH and LOW initial assessment scores on the PROMIS-10 Global Physical Health (PH) and Global Mental Health (MH) measures. Outcomes of interest were patient demographics, health status, and healthcare utilization. Mann–Whitney U and chi-square tests were used to determine differences between groups, and binary logistic regression was used to calculate odds ratios (OR) to determine predictors of PH-LOW and MH-LOW group assignments. Results The PH-LOW and MH-LOW groups contained larger proportions of patients who were African American, non-Hispanic, and non-commercially insured compared to PH-HIGH and MH-HIGH groups (p < .05). The PH-LOW and MH-LOW groups also had a higher Charlson comorbidity index (CCI), higher rates of diabetes and depression, and more appointment cancellations or no-shows (p < .05). African American race (OR 2.54), other race (2.01), having Medi-Cal insurance (OR 3.37), and higher CCI scores (OR 1.55) increased the likelihood of being in the PH-LOW group. African American race (OR 3.54), having Medi-Cal insurance (OR 2.19), depression (OR 3.15), kidney disease (OR 2.66), and chronic obstructive pulmonary disease (OR 1.92) all increased the likeihood of being in the MH-LOW group. Conclusions Our study identified groups of patients with cLBP who are more likely to have lower PH and MH scores. PROMIS-10 GH provides an opportunity to capture and identify quality of life and global health risks in patients with cLBP. Using PROMIS-10 in physical therapy practice could help identify psychosocial factors and quality of life in the population with cLBP.

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“…4,9 Patterns of opioid prescribing vary by patient racial/ethnic characteristics, with Blacks and Hispanic/Latinx patients less likely than whites to receive opioid prescriptions. [10][11][12][13] Some evidence indicates that patients living in lower socioeconomic status (SES) neighborhoods may be more likely to receive opioid prescriptions for new back pain episodes than patients in higher SES neighborhoods. 14 Other patient characteristics associated with variations in opioid prescribing include age, with middleaged patients receiving more opioid prescriptions for back pain from primary care providers (PCPs) compared with those >60 years or <30 years, and insurance type, with Medicaid or self-pay patients receiving more opioid prescriptions than those with private insurance.…”

Section: Introductionmentioning

confidence: 99%

Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care

et al. 2021

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Background: To describe characteristics of patients, providers, and clinics associated with opioid or non-opioid pain medication prescribing patterns for patients who received lower spine imaging in primary care clinics.Methods: In these secondary analyses of the Lumbar Imaging with Reporting of Epidemiology (LIRE) study, a randomized controlled trial conducted in 4 health systems in the United States, we evaluated characteristics associated with receipt of pain medication prescriptions. The outcomes were receipt of prescriptions for opioid or, separately, non-opioid pain medications within 90 days after imaging. Among patients who received opioid or non-opioid prescriptions, we evaluated receipt of multiple prescriptions in the year following imaging. Mixed models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Results: Compared with whites, patients identified as Asian (OR, 0.53; 95% CI, 0.51-0.56), Native Hawaiian/ Pacific Islander (OR, 0.73; 95% CI, 0.64-0.83), multiracial (OR, 0.84; 95% CI, 0.71-0.98) or Black (OR, 0.92; 95% CI, 0.89-0.96) had significantly reduced odds for receiving prescriptions for opioids within 90 days. Patients identified as Native American/Alaska Native had greater odds for receiving prescriptions for non-opioid pain medications within 90 days (OR, 1.12; 95% CI, 1.01-1.24). Receipt of pain prescriptions 120 days before imaging was strongly predictive of subsequent receipt of pain prescriptions across all categories.Conclusions: After adjusting for factors that could affect prescribing, the strongest differences observed in pain-medication prescribing were across racial categories and for patients with previous pain prescriptions. Further research is needed to understand these differences and to optimize prescribing. ( J Am Board Fam Med 2021;34:950-963.

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Associations of Race and Ethnicity With Patient-Reported Outcomes and Health Care Utilization Among Older Adults Initiating a New Episode of Care for Back Pain

Abstract: 3.

Cited by 19 publications

References 50 publications

Racial Differences in Pain, Nutrition, and Oxidative Stress

Racial Differences in Pain, Nutrition, and Oxidative Stress

Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study

Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care

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