Race, Gender, and Primary Language Were Not Associated With Changes in Opioid Prescribing in Children: Results From a Single Institution, 2010 to 2020

Abstract

Background Patients should be prescribed medication based on their medical condition, without prejudice because of their race, gender, or primary language. However, previous research has shown that men are prescribed more medication than women, patients who are White are prescribed more medications than patients who are non-White, and English-speaking people are prescribed more medications than non-English-speaking patients. However, it is unclear whether these differences also occur in pediatric orthopaedic populations.Questions/purposes We asked: (1) Was the amount of opiates prescribed at discharge associated with patient age, gender, race, or primary language? (2) Did the amount of opiates prescribed to patients at discharge change from 2010 to 2020? Methods In a single center, between January 2010 and December 2019, we treated 331 patients younger than 18 years surgically for upper and lower long-bone extremity fractures. Patients were considered eligible if they had a nonpathologic fracture. Femur fractures were not included. Based on these criteria, all patients were eligible. The mean age was 12 6 4 years. The mean weight was 57 6 33 kg. Among these patients, 76% (253 of 331) were boys and 24% (78 of 331) were girls. From the hospital discharge records, we recorded the amount of opiates prescribed at the time of discharge as measured by morphine milligram equivalents (MMEs). We examined the association of age, gender, race, primary language, weight, and year of treatment using this measurement. We determined a patient's race retrospectively by information given by their parents at time of admission. We did not attempt to contact patients to obtain more nuanced information about their racial background. These data were obtained from the electronic health record. The Wilcoxon rank sum test, t-test, or chi-square test was used to assess associations depending on the distribution of variables, as appropriate. Because opioids as measured in MMEs is zeroinflated, a two-part model analysis was used to adjust for confounding variables. One component of the model was for the probability of having any opiate prescription and another was for the mean number of opioids received. Findings were considered statistically significant if p values were < 0.05.Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Is Limited English Proficiency Associated With Differences in Care Processes and Treatment Outcomes in Patients Undergoing Orthopaedic Surgery? A Systematic Review

“…The percentage of patients or observations with limited English proficiency ranged from 0.9% [46, 47] to 50% in a study that used matching to increase comparability between the language groups [30]. Of the studies that reported the frequencies of specific non-English languages in the sample, Spanish was the most common language in 10 studies [6, 17, 35, 39-41, 46, 47, 57, 63], Russian in one study [29], and Greek in one study [13] (Supplemental Digital Content 2; http://links.lww.com/CORR/B286). Two studies categorized the language exposure as English, Spanish, and other in their models [55, 63], and one study separately included six non-English-language categories as well as interpreter need in their primary model [29] (Table 1).…”

“…To address this aim, the findings from all studies were grouped by the three outcome categories for qualitative synthesis. Eight, 10, and 15 studies examined associations between limited English proficiency and clinical care processes [3,6,16,31,35,37,55,57], care processes related to patient engagement [7,11,23,29,39,46,47,49,61,63], and treatment outcomes [1,8,13,14,16,17,25,29,30,35,37,40,41,54,59], respectively. In each outcome category, we categorized the results into associations and no-difference findings and further stratified them as adjusted versus unadjusted estimates, conservatively categorizing estimates as unadjusted where unclear.…”

CORR Insights®: Race, Gender, and Primary Language Were Not Associated With Changes in Opioid Prescribing in Children: Results From a Single Institution, 2010 to 2020

“…This study [2] is important because it provides evidence that it is possible to give equal care to patients, at least regarding opioid prescriptions at discharge. We will need further studies on this topic as well as on other markers of care equality to determine whether this single-institution study in a diverse (46% non-White) urban center in the Northeastern United States is generalizable to other regions and healthcare settings and to better understand the existing discrepancies in access to and quality of care.…”

“…First, it would be helpful to have more information in the form of studies like the current study, from other institutions, to evaluate the generalizability of Begley et al's [2] findings. Other institutions could perform similar types of inquiries either as internal audits for institutional quality improvement or published studies so results can be compared across institutions and so the landscape of care equity in pediatric orthopaedics can be better understood.…”

“…In the current study, Begley et al [2] investigated whether race, gender, or primary language is associated with opioid prescribing at the time of discharge for patients younger than 18 years who underwent surgery for an acute long-bone fracture. After controlling for age and weight, there were no differences in opioid prescriptions provided at discharge in relation to patient race, gender, or primary language.…”