title: Is race/ethnicity related to the presence or severity of pain in colorectal and lung cancer?
abstract: BACKGROUND
  Developing interventions to address racial/ethnic cancer pain disparities requires exploration of the role of socioeconomic status, health status, and pain severity from the time of diagnosis.
  
  
  OBJECTIVE
  To examine patterns of disparities in cancer pain by evaluating differences by race/ethnicity in the odds of reporting pain and in pain severity, controlling for key patient-level covariates.
  
  
  METHODS
  This study used data from a nationally representative cohort of colorectal and lung cancer patients. Multivariable logistic regression was conducted to examine the relationship between race/ethnicity and reporting pain. Multivariable linear regression was then conducted, among those who reported pain, to determine differences in pain severity by race/ethnicity.
  
  
  RESULTS
  The cohort included 5761 individuals (14% black, 7% Hispanic/Latino, 6% Asian or Pacific Islander, and 3% multiracial), among whom 48% reported pain. The adjusted odds of reporting differed only for multiracial patients, who were more likely to report pain than whites (odds ratio: 1.54; P = 0.036). However, among those with pain, severity was higher for black patients (β = 6.6; P ≤ 0.001) and multiracial patients (β = 4.5; P = 0.036) relative to white patients. Lower educational attainment, depressed affect, and lower levels of wealth also were associated with higher pain severity.
  
  
  CONCLUSIONS
  Although the odds of experiencing pain differed only for multiracial patients, among those reporting pain, both blacks and multiracial individuals reported higher pain severity than whites. Sociodemographic status, health status, and depression were associated with severity but did not explain the disparity. Interventions to address these disparities will need to focus on reported severity and patient-level factors.
authors.affiliation: Ann Arbor VA Center for Clinical Management Research, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: makathry@med.umich.edu.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Martinez
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Claire F
authors.initials: CF
authors.lastname: Snyder
authors.affiliation: WellPoint, Thousand Oaks, California, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Dy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000208:ethnology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008175:Lung Neoplasms / Q000208:ethnology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000208:ethnology* / Q000503:physiopathology*; D010147:Pain Measurement; D011446:Prospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Cancer pain; colorectal cancer; health disparities; lung cancer; patient-reported outcomes; quality of life
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