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Racial Disparities Found in Pain Drugs for Appendicitis

Black children less likely to get opioid medications

Race appears to affect the odds that a child or teen with appendicitis, a painful condition requiring surgery, will get pain medication — particularly opioid medication, according to a new study.

“I’ve seen a lot of patients with appendicitis; it’s a very painful surgical condition,” lead author Dr. Monika K. Goyal of the Children’s National Health System in Washington, D.C., told Reuters Health. “Pain management with opioids is one of the mainstays of treatment.

“We were surprised that less than 60%of all kids received any analgesia … and among the kids that actually received it, why there were such marked racial differences in use of opioids,” she said.

Previous studies have documented racial disparities in emergency department treatment or management of adult patients, but these results specifically among children are particularly striking, she said.

Goyal and her coauthors used data from the National Hospital Ambulatory Medical Care Survey from 2003 to 2010 on almost one million patients 21 years of age or younger who were diagnosed with appendicitis in an emergency room. Only 57% received some kind of pain medication. Roughly 41% received an opioid medication.

Twenty-one percent of black children, compared to more than 40% of white children, received an opioid, the researchers reported in JAMA Pediatrics. Black children with moderate pain were less likely to receive any pain medication than white patients, and black patients with severe pain were less likely to receive opioids than white patients.

“It should also be noted that these data were collected between 2003 and 2010, so some of this information is over a decade old and one might hope that things would be different if the data were collected today,” said Dr. Eric W. Fleegler of Boston Children’s Hospital and Harvard Medical School.

“Not all patients with appendicitis experience the same pain — it is highly variable depending on the duration of symptoms and the degree of inflammation,” added Dr. Neil L. Schechter, Fleegler’s colleague and his coauthor on an editorial published with the research. “Typically, however, analgesics are prescribed for appendicitis.”

“Really understanding racial disparities in health care is extremely important,” Goyal said. “Once we acknowledge that these types of disparities exist, we can move on to developing interventions to achieve health equity.”

National benchmarks can help hospitals gauge how they are doing compared to others around the country, Fleegler and Schechter said in an email. If they are using more or less opioids for a given condition, then an education program for staff helping them look critically at their own practice may be helpful, they said.

Sources: Reuters; September 14, 2015; JAMA Network; September 14, 2015

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