Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting
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Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting Louis Ehwerhemuepha 1 & Candice D. Donaldson 2,3 & Zeev N. Kain 3,4,5 & Vivian Luong 2,3 & Michelle A. Fortier 3,5,6 & William Feaster 1 & Michael Weiss 7 & Daniel Tomaszewski 8 & Sun Yang 9 & Michael Phan 10 & Brooke N. Jenkins 2,3,4 Received: 30 July 2020 / Revised: 19 September 2020 / Accepted: 21 September 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Background This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting. Methods Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children’s hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering. Results There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer nonopioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with “other” insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage. Conclusion Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care. Keywords Opioids . Pediatric pain . Electronic medical record . Race and ethnicity . Disparities
Introduction The unprecedented rates of opioid misuse and related deaths in the USA have commanded the attention of public health professionals and governmental health agencies [1]. It was
* Brooke N. Jenkins [email protected]
reported that the death rate from abuse of opioids quadrupled between 1999 and 2010, a rate which continues to increase and plague the nation [2, 3]. In 2016 alone, the USA reported over 42,000 fatal opioid overdoses, signifying a 27% increase in mortality rate from 2015 [4]. Also, in 2016, 11.8 million
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Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA 92697, USA
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Population He
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