The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

Abstract

BACKGROUND: Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. OBJECTIVES: (1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES. DESIGN: We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region. MAIN MEASURES: Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient's zip code. RESULTS: Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3 % vs. 42.5 %, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66-0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68-0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates. CONCLUSIONS: Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.

Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis

“…26 Ndlovu 26 also found that the majority of patients received no pharmacologic therapy, much the same as this study. However, this study presents contrast with the findings of Joynt et al 15 , which noted low nSES was associated with a 24% decrease in odds of opioid prescription. However, the study by Joynt et al 15 was based in the emergency room (ER) where ap- proaches to care may be different.…”

“…However, this study presents contrast with the findings of Joynt et al 15 , which noted low nSES was associated with a 24% decrease in odds of opioid prescription. However, the study by Joynt et al 15 was based in the emergency room (ER) where ap- proaches to care may be different. Further, the provider-patient relationship in the ER environment is likely quite different from the primary care setting as well.…”

“…[12][13][14] In emergency department (ER) and primary care visits for pain, studies have demonstrated that African Americans and women are less likely to receive opioids for acute pain. 12,[15][16][17] These racial differences are thought to contribute to the disproportionate effect of the opioid epidemic on the white population. 18 The influence of the social determinants of health cannot be fully explored without addressing socioeconomic status (SES).…”

“…25 To further characterize the influence of nSES, studies have been conducted that suggest nSES may influence pain treatment modality. Joynt et al 15 examined how race and a measure of nSES may influence treatment of pain. In particular, lower nSES was associated with a lower likelihood of patient's receiving an opioid prescription, independent of race.…”

Capsule Commentary on Joynt et al., The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States

“…1 Patients from poorer neighborhoods and African-Americans and Latinos were less likely to be prescribed opioids. The effects for race and ethnicity persisted even when neighborhood factors were controlled.…”