White Patients Are More Likely to Receive Opioids for Pain in Long Bone Fractures

A study found that pain scores did not dictate whether long bone fracture patients were treated with opioids. Instead, race and age played a significant role in determining what class of pain medication patients received.

The study authors retrospectively reviewed de-identified data from 115 patients admitted to the emergency department of a level 2 trauma center in Florida. Patients diagnosed with an upper or lower extremity long bone fracture were evaluated for age (pediatric [<19 years], adult [19–64], or geriatric [≥65]), sex (male or female), race (white or non-white), pain-scale rating (0–10), medication class (opioids, acetaminophen [APAP], or non-steroidal anti-inflammatory agents [NSAIDs]), and length of time for medication administration—which included time of patient admission, physician medication order, and medication administration.

Final analysis included 115 patients with an average overall age of 29.0 ± 25.8 years; 55% of patients (n=63) were male. Most patients (n=64; 55%) identified as non-white; four of these patients were black, while the rest were Hispanic. Fifty-one patients (44%) identified as white. There were 65 pediatric patients (57%; age, 10.35 ± 3.00 years), 33 adult patients (29%; age, 40 ± 13 years), and 17 geriatric patients (15%; age, 78 ± 8 years). Most patients (n=85; 74%) had upper extremity fractures. About two-thirds of patients (n=77; 67%) were diagnosed with a single fracture; 32% (n=37) had multiple fractures. Most patients (37%) had Medicaid insurance; 35% had private insurance, 16% had self-pay, and 12% had Medicare. Adults arriving by EMS, compared to other classes, were more likely to receive opiates.

Average pain scores were significantly higher for females than males (7.08 ± 2.66 vs. 5.73 ± 3.07; P=0.017). Medication class administration for females was: NSAIDs, 53.85%; opiates, 38.46%; and APAP, 7.69%. For males, the breakdown was: NSAIDs, 65.08%; APAP, 28.57%; and APAP, 6.35%.

When assessing by race, pain scores did not largely differ between white and non-white patients. But white patients were significantly more likely to receive opiates than non-white patients (70% vs. 50%; P<0.0001).

In the age analysis, medication administration in the pediatric group was: NSAIDs, 76.92%; APAP, 12.31%; and opiates, 10.77%. For adults, no patients received APAP; 54.55% received opiates, and 45.45% received NSAIDs. Among geriatric patients, no patients received APAP; 76.47% received opiates, and 23.53% received NSAIDs.

The study was published in the Journal of Racial and Ethnic Health Disparities.

“Our study found racial disparities in the type of analgesic ordered for long bone fractures, and the type of medication selected varied by age, but not by pain score. This was in part due to the white patients in our sample being older, and that pediatric patients were less likely to receive narcotics. Still, controlling for age with our small sample size did trend toward a significant relationship between race and opioid medications,” the researchers concluded, adding, “Our study lends evidence to the growing body of literature on the impact of unconscious bias and racial disparities in US healthcare.”