The researchers from Brown University School of Public Health and colleagues conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between black and white patients as they transitioned back to the community setting.
The study, which involved 164,170 older adults with hip fracture, stratified beneficiaries by whether they received institutional postacute care (PAC). The key outcomes were defined as 1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). The participants had a mean age of 82.7 years and were 75% female. Most, 72%, received PAC, and 46% were prescribed opioids after the fracture.
The results published in the Journal of the American Geriatrics Society noted that overall use of opioids in the community was similar between black and white beneficiaries.
On the other hand, the study team found that black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI, –264 to –69] fewer MMEs [–248 mg oxycodone]; no PAC: 167 [95% CI, –274 to –62] fewer MMEs [–251 mg oxycodone]) and average MME per days’ supply of medication (PAC: –3.0 [–4.6 to –1.4] fewer MMEs per day [–4.5 mg oxycodone]; no PAC: –4.7 [–4.6 to –1.4] fewer MMEs per day [–7.1 mg oxycodone]).
In secondary analyses, the study reported that Asian beneficiaries experienced the greatest differences (e.g., 617-653 fewer cumulative mg oxycodone).
“Racial differences exist in pain management for Medicare beneficiaries after a hip fracture,” the authors pointed out. “Future work should examine whether these differences result in disparities in short- and long-term health outcomes.”
That study was in line with another study from earlier this year in Frontiers in Public Health.
Looking at Medicaid patients who had orthopedic trauma, Emory University–led researchers found that patients with disabilities (odds ratio [OR], 0.75; 95% CI, 0.71-0.80), prolonged hospitalizations, and both black (OR, 0.87; 95% CI, 0.83-0.92) and Hispanic patients (OR, 0.72; 95% CI, 0.66-0.77) had lower odds ratio of receiving an opioid prescription following trauma relative to white patients. They added that black and Hispanic patients received lower prescription doses compared with white patients.
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