Racial Differences in Opioid Prescribing for Children in the United States

Groenewald CB, Rabbitts JA, Hansen E, E Palermo TM.  Pain 2018;159:2050

Reviewed by Sabine Kost-Byerly, MD
Director, Pediatric Pain Management,
Director, Multi-disciplinary Pediatric Pain Clinic, Kennedy Krieger Institute
Associate Professor of Anesthesiology and Critical Care Medicine,
Johns Hopkins University School of Medicine
Baltimore, Maryland

Racial differences in provision of medical care have been documented in adults and children in the US.  This study aimed to examine racial or ethnic differences in pediatric outpatient analgesic opioid and non-opioid prescription practice and possible correlation with race and ethnicity of providers.

Methods
The study is a secondary analysis of data of children 0-17 years of age from the 2003-2014 Medical Expenditure Panel Surveys (MEPS), a representative survey of individuals, households, and their medical providers, including pharmacies, across the United States. (http://meps.ahrq.gov/mepsweb/) Race and ethnicity was either self-defined (patient) or as perceived by the patient (provider).  Analgesic prescriptions were solely recorded for outpatient care, excluding those from hospitalizations and ED visits.

Results
Almost 114K children were included. Racial distributions changed from 2003 (60% white) to 2014 (50% white). Ratio of Hispanic children increased and of black children was stable.  Rates of opioid prescriptions were higher for white than for minority children except for Native American children who had equal rates. Non-opioid analgesics were more commonly prescribed for minority children. No racial differences were observed in likelihood of opioid prescriptions based on provider race.  Race concordance with their providers did not result in minority children receiving opioids more often than in non-concordant relationships, indeed black children received significantly fewer opioids from black than from white providers.

Discussion
Racial disparities in outpatient prescriptions exist between white and minority children in that the former receive more opioids and the latter more non-opioids. Patient-provider race and ethnicity concordance and discordance is only one of the factors requiring more exploration to better understand beliefs and biases affecting therapeutic choices.