Acute abdominal pain is one of the most common reasons for patients to visit the ED, but few studies have examined if there are racial and ethnic disparities for how this pain is managed. Prior research focusing on the management of acute abdominal pain in the ED setting has yielded conflicting results. Adil H. Haider, MD, MPH, FACS, and colleagues had a study published in Medical Care that sought to gain a better understanding of the potential racial and ethnic differences in the use of analgesics in the ED to manage this pain.

Using data from the CDC’s National Hospital Ambulatory Medical Care Survey, the investigators analyzed patients aged 18 and older who were seen for non-traumatic abdominal pain at 350 EDs over a span of about 5 years across the United States. Of the more than 6,700 ED visits included in the analysis, 61.2% of the patients were white, 20.1% were black, 14.0% were Hispanic, and 4.7% belonged to other racial or ethnic groups. The study group compared rates of analgesic medication use among these racial and ethnic groups, and then accounted for differences in patient and hospital characteristics.

 

Observed Disparities

According to the results, white patients were most likely to receive any analgesic medication (56.8%) when compared with Hispanic patients (52.8%), black patients (50.9%), and people who were classified as other racial or ethnic groups (46.6%). “Black patients were the least likely to receive narcotic analgesics despite having similar rates of severe pain as other racial and ethnic groups,” says Dr. Haider.

After adjusting for other factors, blacks, Hispanics, and patients of other races and ethnicities were 22.0% to 30.0% less likely to receive any analgesic medication than white patients. “These patient groups were also 17.0% to 30.0% less likely to receive narcotic analgesics when compared with white patients,” Dr. Haider says. These correlations persisted for patients with moderate-to-severe pain, but were insignificant for those presenting with mild pain.

The study also found black, Hispanic, and other patients were more likely to experience longer ED waiting and visit times than white patients. They were also less likely to be admitted to the hospital. In addition, differences in pain medication use were concentrated in hospitals that treated the largest percentages of minority patients and among those reporting the severest pain. Black patients had the highest odds of being undertreated for acute abdominal pain.

 

Important Implications

Findings from the study add to the overwhelming evidence that racial and ethnic disparities exist and are endemic in healthcare settings. “Equality is the cornerstone of medicine, and improving doctor-patient communication can play a crucial role in achieving equality,” says Dr. Haider. “It’s critical that EDs address disparities head-on. Clinicians need to be mindful of the patients they treat and think about the efforts their organizations are taking to eliminate disparities. If there aren’t any, they should start conversations with their colleagues to take action. There are also research opportunities to investigate underlying mechanisms of disparities in healthcare. These efforts are critical for pain management as well as all other aspects of patient care.”

References

Shah AA, Zogg CK, Zafar SN, et al. Analgesic access for acute abdominal pain in the emergency department among racial/ethnic minority patients: a nationwide examination. Med Care. 2015;53:1000-1009. Available at: http://journals.lww.com/lww-medicalcare/Abstract/2015/12000/Analgesic_Access_for_Acute_Abdominal_Pain_in_the.3.aspx.

Johnson TJ, Weaver MD, Borrero S, et al.Association of race and ethnicity with management of abdominal pain in the emergency department. Pediatrics. 2013;132:e851-e858.

Shafi S, Gentilello LM. Ethnic disparities in initial management of trauma patients in a nationwide sample of emergency department visits. Arch Surg. 2008;143:1057-1061; discussion 1061.

Wu BU, Banks PA, Conwell DL. Disparities in emergency department wait times for acute gastrointestinal illnesses: results from the National Hospital Ambulatory Medical Care Survey, 1997-2006. Am J Gastroenterol. 2009;104:1668-1673.