title: Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States.
abstract: BACKGROUND
  The recent Institute of Medicine Report assessing the state of pain care in the United States acknowledged the lack of consistent data to describe the nature and magnitude of unrelieved pain and identify subpopulations with disproportionate burdens.
  
  
  OBJECTIVE
  We synthesized 20 years of cumulative evidence on racial/ethnic disparities in analgesic treatment for pain in the United States. Evidence was examined for the 1) magnitude of association between race/ethnicity and analgesic treatment; 2) subgroups at an increased risk; and 3) the effect of moderators (pain type, setting, study quality, and data collection period) on this association.
  
  
  METHODS
  United States studies with at least one explicit aim or analysis comparing analgesic treatment for pain between Whites and a minority group were included (SciVerse Scopus database, 1989-2011).
  
  
  RESULTS
  Blacks/African Americans experienced both a higher number and magnitude of disparities than any other group in the analyses. Opioid treatment disparities were ameliorated for Hispanics/Latinos for "traumatic/surgical" pain (P = 0.293) but remained for "non-traumatic/nonsurgical" pain (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.64-0.77, P = 0.000). For Blacks/African Americans, opioid prescription disparities were present for both types of pain and were starker for "non-traumatic/nonsurgical" pain (OR = 0.66, 95% CI = 0.59-0.75, P = 0.000). In subanalyses, opioid treatment disparities for Blacks/African Americans remained consistent across pain types, settings, study quality, and data collection periods.
  
  
  CONCLUSIONS
  Our study quantifies the magnitude of analgesic treatment disparities in subgroups of minorities. The size of the difference was sufficiently large to raise not only normative but quality and safety concerns. The treatment gap does not appear to be closing with time or existing policy initiatives. A concerted strategy is needed to reduce pain care disparities within the larger quality of care initiatives.
authors.affiliation: Department of Biobehavioral Health Sciences, New Courtland Center for Transitions & Health, Center for Bioethics, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA. meghanis@nursing.upenn.edu
authors.forename: Salimah H
authors.initials: SH
authors.lastname: Meghani
authors.forename: Eeeseung
authors.initials: E
authors.lastname: Byun
authors.forename: Rollin M
authors.initials: RM
authors.lastname: Gallagher
mesh_terms: D000698:Analgesia / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use*; D005006:Ethnicity; D006297:Health Services Accessibility / Q000639:trends; D006801:Humans; D054525:Minority Health / Q000639:trends; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology*; D044469:Racial Groups; D014481:United States / Q000453:epidemiology
chemical_list: D000700:Analgesics