Racial/Ethnic Disparities in Pain Treatment

Abstract

Background: Despite the critical role that Emergency Medical Services (EMS) provides in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined. Objective: To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS. Research Design: A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury. Results: Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%–30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%–43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%–42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%–32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%–41%; P<0.05) when compared with white patients. Conclusions: Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.

A Systematic Literature Review of Hispanic Adults’ Experiences With the Emergency Medical Services System in the United States Between 2000 and 2021

“…All of the studies assessed Hispanics' experiences with the EMS system in the United States, although some studies focused on the national (n = 15), 2,7,10,11,13,16,21,22,24,28,31,35,36,40,41 state (n = 11), 6,14,15,17,18,20,25,39,42,44,46 or local level (n = 17). 12,19,23,26,27,29,30,[32][33][34]37,38,45,[47][48][49] Hispanic sample size ranged from 1 to 99 (n = 4), 14,32,40,42,47 100 to 999 (n = 17), 12,18,19,27,…”

<p>Chronic Noncancer Pain Management and Systemic Racism: Time to Move Toward Equal Care Standards</p>

“…22 On a more general basis, myriad studies have demonstrated that BIPOC patients have historically been less likely to receive opioid analgesia than are White patients across ages and painful conditions. [23][24][25][26][27][28][29][30][31][32][33] Unfortunately, recent studies continue to demonstrate that BIPOC patients presenting with painful conditions continue to face disadvantages regarding assessment and treatment in EDs, [34][35][36][37][38] with patient perceptions of this disparity serving as a barrier to even seeking emergency care. 39 Similarly, a 2018 study of traumatically injured individuals requiring emergency medical services (EMS) transport to hospitals found that significantly fewer Black patients received opioids prehospital compared to other ethnic groups.…”

“…40 Similar findings were obtained from a more recent study. 34 Studies have found that implicit bias among providers affects their clinical judgement, decisions and behavior. Racial and ethnic stereotypes also influence assessments and treatment, especially with high pain intensity self-report among BIPOC patients.…”

Preliminary study: quantification of chronic pain from physiological data

“…Additionally, quantification of pain is important because there is increasing concern that gender, race, age, and intellectual development disabilities may be involved in diagnostic delays as well as overtreatment or undertreatment of pain. 8 , 23 , 52 , 66…”