Background: Prior evidence suggests that healthcare disparities exist in a variety of healthcare settings and for multiple medical conditions. For patients with acute pain, it is unknown if analgesia medication is prescribed at different rates to racial and ethnic minorities. This review aims to synthesize available studies that analyzed analgesia utilization for acute pain management in Black and Hispanic patients compared to white and non-Hispanic patients in US Emergency Departments.
Methods: A systematic review was performed using established methodology. Inclusion criteria include research conducted between 1990 and 2018, US-based ED or urgent care settings, adult patients, studies that compared White patients to an ethnic or racial minority for acute pain. Studies were excluded that focused on chronic pain, chest pain, post-operative pain, case reports and survey studies. Acute pain was categorized by traumatic or non-traumatic causes and analgesia was categorized by opiate or non-opiate class. Two independent reviewers were involved in each stage of review. Following data abstraction, meta-analysis was performed using a fixed effects and random-effects model to determine primary outcome of analgesia administration stratified by racial and ethnic classification.
Results: 763 articles were screened for eligibility and ultimately fourteen studies met inclusion criteria. Thirteen studies compared Black and White patients and seven compared Hispanic and Non-Hispanic patients. In total, study population included 7070 non-Hispanic White patients, 1538 Hispanic patients, 3125 Black patients and 50.3% Female. Black patients were less likely than White to receive analgesia medication for acute pain: OR 0.64 [95%-CI: 0.55-0.75, fixed effects model] and OR 0.60 [95%-CI, 0.43-0.83, random effects model]. Hispanics were also less likely to receive analgesia administration in the ED: OR 0.70 [95%-CI, 0.57-0.87, fixed effects model] and 0.75 [95%-CI, 0.52-1.09, random effects model.
Conclusion: In this meta-analysis, Black and Hispanic patients received less analgesia medication for acute pain in US EDs compared to White non-Hispanic patients. Further research is needed to examine patient reported outcomes in addition to minority groups other than Black and Hispanic. Trial registration: Registration number CRD42018104697 in PROSPERO.