title: Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination.
abstract: BACKGROUND
  Prior studies of acute abdominal pain provide conflicting data regarding the presence of racial/ethnic disparities in the emergency department (ED).
  
  
  OBJECTIVE
  To evaluate race/ethnicity-based differences in ED analgesic pain management among a national sample of adult patients with acute abdominal pain based on a uniform definition.
  The 2006-2010 CDC-NHAMCS data were retrospectively queried for patients 18 years and above presenting with a primary diagnosis of nontraumatic acute abdominal pain as defined by the American Association for the Surgery of Trauma. Independent predictors of analgesic/narcotic-specific analgesic receipt were determined. Risk-adjusted multivariable analyses were then performed to determine associations between race/ethnicity and analgesic receipt. Stratified analyses considered risk-adjusted differences by the level of patient-reported pain on presentation. Secondary outcomes included: prolonged ED-LOS (>6 h), ED wait time, number of diagnostic tests, and subsequent inpatient admission.
  
  
  RESULTS
  A total of 6710 ED visits were included: 61.2% (n=4106) non-Hispanic white, 20.1% (n=1352) non-Hispanic black, 14.0% (n=939) Hispanic, and 4.7% (n=313) other racial/ethnic group patients. Relative to non-Hispanic white patients, non-Hispanic black patients and patients of other races/ethnicities had 22%-30% lower risk-adjusted odds of analgesic receipt [OR (95% CI)=0.78 (0.67-0.90); 0.70 (0.56-0.88)]. They had 17%-30% lower risk-adjusted odds of narcotic analgesic receipt (P<0.05). Associations persisted for patients with moderate-severe pain but were insignificant for mild pain presentations. When stratified by the proportion of minority patients treated and the proportion of patients reporting severe pain, discrepancies in analgesic receipt were concentrated in hospitals treating the largest percentages of both.
  
  
  CONCLUSIONS
  Analysis of 5 years of CDC-NHAMCS data corroborates the presence of racial/ethnic disparities in ED management of pain on a national scale. On the basis of a uniform definition, the results establish the need for concerted quality-improvement efforts to ensure that all patients, regardless of race/ethnicity, receive optimal access to pain relief.
authors.affiliation: *Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health and the Department of Surgery, Brigham & Women's Hospital, Boston, MA †Division of General Surgery, Mayo Clinic, Phoenix, AZ ‡Department of Surgery, Howard University Hospital, Washington, DC §Division of General Internal Medicine ∥Department of Emergency Medicine, The Johns Hopkins University School of Medicine ¶The Johns Hopkins Center on Aging and Health Departments of #Health, Behavior, and Society **Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Adil A
authors.initials: AA
authors.lastname: Shah
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Chapital
authors.forename: Susan M
authors.initials: SM
authors.lastname: Peterson
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Havens
authors.forename: Roland J
authors.initials: RJ
authors.lastname: Thorpe
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy* / Q000208:ethnology; D059787:Acute Pain; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage*; D019937:Diagnostic Techniques and Procedures; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000700:Analgesics; D009294:Narcotics