Racial Disparities in Postpartum Pain Management :

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="title" id="d375614e106">Objective:</h5> <p id="P1">To evaluate racial and ethnic differences in women’s postpartum pain scores, inpatient opioid administration, and discharge opioid prescriptions. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="title" id="d375614e111">Methods:</h5> <p id="P2">We conducted a retrospective cohort study of all deliveries at a single, high-volume tertiary care center from December 1, 2015, through November 30, 2016. Women were included if they self-identified as non-Hispanic white, non-Hispanic black, or Hispanic, were at least 18 years of age, and did not have documented allergies to non-steroidal anti-inflammatory drugs or morphine. Medical records were queried for three outcomes: 1) patient-reported postpartum pain score (on a scale of 0 to 10) at discharge (dichotomized &lt;5 or ≥5); 2) inpatient opioid dosing during postpartum hospitalization (reported as morphine milligram equivalents per postpartum day); and 3) receipt of an opioid prescription at discharge. The associations between each of these outcomes and maternal race–ethnicity were assessed using multivariable logistic regression models with random effects to account for clustering by discharge physician. A sensitivity analysis was conducted in which women of different race and ethnicity were matched using propensity scores. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="title" id="d375614e116">Results:</h5> <p id="P3">A total of 9,900 postpartum women were eligible for analysis. Compared to non-Hispanic white women, Hispanic and non-Hispanic black women had significantly greater odds of reporting a pain score of ≥ 5 (aOR 1.61; 95% 1.26 to 2.06 and aOR 2.18; 95% 1.63 to 2.91, respectively), but received significantly fewer inpatient morphine milligram equivalents/day (aβ −5.03; 95% CI −6.91 to −3.15 and aβ −3.54; 95% CI −5.88 to −1.20, respectively). Additionally, Hispanic and non-Hispanic black women were significantly less likely to receive an opioid prescription at discharge (aOR 0.80; 95% CI 0.67 to-0.96 and aOR 0.78; 95% CI 0.62 to 0.98) compared to non-Hispanic white women. Results of the propensity score analysis largely corroborated those of primary analysis, with the exception that the difference in inpatient morphine milligram equivalents/day between non-Hispanic white and non-Hispanic black women did not reach statistical significance. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="title" id="d375614e121">Conclusion:</h5> <p id="P4">Hispanic and non-Hispanic black women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain. </p> </div><p id="P5">Hispanic and non-Hispanic black women experience postpartum disparities in pain management that cannot be explained by less perceived pain. </p>