Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting.
Adolescent
Analgesics, Opioid
/ therapeutic use
California
Child
Child, Preschool
Cross-Sectional Studies
Ethnicity
/ statistics & numerical data
Female
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Insurance, Health
/ statistics & numerical data
Male
Medicare
/ statistics & numerical data
Racial Groups
/ statistics & numerical data
United States
Disparities
Electronic medical record
Opioids
Pediatric pain
Race and ethnicity
Journal
Journal of racial and ethnic health disparities
ISSN: 2196-8837
Titre abrégé: J Racial Ethn Health Disparities
Pays: Switzerland
ID NLM: 101628476
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
30
07
2020
accepted:
21
09
2020
revised:
19
09
2020
pubmed:
2
10
2020
medline:
9
11
2021
entrez:
1
10
2020
Statut:
ppublish
Résumé
This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting. Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children's hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering. There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with "other" insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage. Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.
Sections du résumé
BACKGROUND
BACKGROUND
This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting.
METHODS
METHODS
Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children's hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering.
RESULTS
RESULTS
There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with "other" insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage.
CONCLUSION
CONCLUSIONS
Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.
Identifiants
pubmed: 33000430
doi: 10.1007/s40615-020-00882-9
pii: 10.1007/s40615-020-00882-9
pmc: PMC8552771
mid: NIHMS1748473
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1232-1241Subventions
Organisme : NCI NIH HHS
ID : K08 CA179084
Pays : United States
Informations de copyright
© 2020. W. Montague Cobb-NMA Health Institute.
Références
Pediatrics. 2012 May;129(5):832-8
pubmed: 22529273
Am J Public Health. 2003 May;93(5):742-8
pubmed: 12721135
BMC Med Inform Decis Mak. 2020 Jun 19;20(1):115
pubmed: 32560653
J Pain Res. 2020 Feb 17;13:411-417
pubmed: 32110089
JAMA Pediatr. 2015 Nov;169(11):996-1002
pubmed: 26366984
N Engl J Med. 2014 May 29;370(22):2063-6
pubmed: 24758595
Clin J Pain. 2014 Jul;30(7):557-64
pubmed: 24281273
J Pain. 2009 Dec;10(12):1187-204
pubmed: 19944378
Anesth Analg. 2017 Nov;125(5):1569-1587
pubmed: 29049110
Pediatrics. 2009 Jul;124(1):378-80
pubmed: 19564322
J Perinatol. 2008 Jan;28(1):55-60
pubmed: 18165830
Pain. 2001 Aug;93(2):173-183
pubmed: 11427329
Pain. 2016 Oct;157(10):2173-2178
pubmed: 27227693
Clin Orthop Relat Res. 2011 Jul;469(7):1859-70
pubmed: 21249483
Prev Med. 2020 Mar;132:105972
pubmed: 31904397
MMWR Surveill Summ. 2015 Oct 16;64(9):1-14
pubmed: 26469747
J Health Care Poor Underserved. 2010 Feb;21(1):229-36
pubmed: 20173265
JAMA. 2016 Apr 19;315(15):1624-45
pubmed: 26977696
Clin Pediatr (Phila). 2018 Jul;57(8):937-944
pubmed: 29082772
Curr Pain Headache Rep. 2019 May 1;23(6):40
pubmed: 31044343
JAMA Netw Open. 2018 Dec 7;1(8):e186558
pubmed: 30646334
J Surg Res. 2020 Sep;253:254-261
pubmed: 32388388
Am J Public Health. 2003 Dec;93(12):2067-73
pubmed: 14652336
Annu Rev Public Health. 2015 Mar 18;36:559-74
pubmed: 25581144
J Pediatr. 2017 Jul;186:150-157.e1
pubmed: 28476461
Addict Behav. 2015 Jun;45:14-21
pubmed: 25622102
Eur J Pain. 2009 Nov;13(10):1089-95
pubmed: 19726211
Paediatr Anaesth. 2013 Jun;23(6):475-95
pubmed: 23570544
J Shoulder Elbow Surg. 2018 Jun;27(6S):S35-S42
pubmed: 29519585
J Prim Care Community Health. 2017 Jul;8(3):169-175
pubmed: 28606031
Pain. 2005 Jan;113(1-2):20-6
pubmed: 15621360
Pediatrics. 2017 Apr;139(4):
pubmed: 28320868
West J Emerg Med. 2015 May;16(3):372-80
pubmed: 25987909
Anesth Analg. 2002 Nov;95(5):1224-9, table of contents
pubmed: 12401598
Med Care. 2005 Oct;43(10):960-9
pubmed: 16166865
Pediatrics. 2015 Nov;136(5):e1169-77
pubmed: 26504126
J Cardiovasc Pharmacol. 2006;47 Suppl 1:S82-6
pubmed: 16785836
Hosp Pediatr. 2018 Sep;8(9):578-587
pubmed: 30093373
Hosp Pediatr. 2020 Jan;10(1):43-51
pubmed: 31811046
JAMA. 2008 Jan 2;299(1):70-8
pubmed: 18167408
JAMA. 2013 Feb 20;309(7):657-9
pubmed: 23423407
Semin Perinatol. 2019 Apr;43(3):123-131
pubmed: 30711195
Pain Med. 2009 Jan;10(1):11-34
pubmed: 18992039
Am J Public Health. 2013 Jan;103(1):92-8
pubmed: 23153155
Pediatrics. 2018 Jan;141(1):
pubmed: 29203521
JAMA Pediatr. 2016 Dec 1;170(12):1195-1201
pubmed: 27802492
JAMA Netw Open. 2018 Dec 7;1(8):e186161
pubmed: 30646317
Pediatrics. 2018 Aug;142(2):
pubmed: 30012559
PLoS One. 2016 Aug 08;11(8):e0159224
pubmed: 27501459
Gen Hosp Psychiatry. 2011 Sep-Oct;33(5):423-8
pubmed: 21749839
Psychosom Med. 1999 May-Jun;61(3):346-54
pubmed: 10367615