title: Access to care for chronic pain: racial and ethnic differences.
abstract: Access to medical care is a major national issue, and several surveys suggest that racial and ethnic differences influence access to care for chronic pain problems. To evaluate the influence of race and ethnicity on access to treatment for chronic pain, a cross-sectional telephone survey was performed in a nationally representative sample of 454 white, 447 African-American, and 434 Hispanic subjects with pain for > or =3 months. Questions explored demographics, pain and its treatment, and perceived access to care. A composite "access" variable combined actual consultation with perceived access. Hispanics were younger, least likely to be insured, and had the least education and lowest income; 61% spoke Spanish at home. Hispanics were significantly less likely to have consulted a primary care practitioner for pain (70%) than whites (84%) or African-Americans (85%). A lower likelihood of consultation also was associated with speaking Spanish, being male, being relatively young (18-34 years old) or single, having limited education, and not being employed. Low "access" to care was associated with being Hispanic and speaking Spanish, being younger or male, having low income or limited education, being employed, and agreeing that financial concerns prevented pain treatment. High "access" was associated with being white or African-American; being older or female or living in a suburban area; having insurance, higher income, or college education; and being unemployed. In multivariate models, low "access" was associated with Hispanic ethnicity and agreement that financial concerns prevented pain treatment. High "access" was associated with more severe pain, having insurance or an income of US 25,000 dollars to US 74,000 dollars, and agreeing that "A doctor or other health care provider is the first person I would go to to discuss my pain." These data suggest that race/ethnicity, other demographic characteristics, and socioeconomic factors influence access to pain care. Hispanic ethnicity predicts limited access.
  
  
  CONCLUSIONS
  The influence of race and ethnicity on access to health care is a major issue in the United States. A national telephone survey suggests that race and ethnicity, along with other demographic and socioeconomic factors, influence access to care for chronic pain.
authors.affiliation: Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York 10003, USA.
authors.forename: Marisa
authors.initials: M
authors.lastname: Nguyen
authors.forename: Carlos
authors.initials: C
authors.lastname: Ugarte
authors.forename: Ivonne
authors.initials: I
authors.lastname: Fuller
authors.forename: Gregory
authors.initials: G
authors.lastname: Haas
authors.forename: Russell K
authors.initials: RK
authors.lastname: Portenoy
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002908:Chronic Disease; D003625:Data Collection; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007341:Insurance; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000191:economics / Q000208:ethnology*; D059408:Pain Management; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data