Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020
Abstract Objectives To examine racial and ethnic disparities in postoperative opioid prescribing. Data sources Electronic health records (EHR) data across 24 hospitals from a healthcare delivery system in Northern California from January 1, 2015 to February 2, 2020 (study period). Study design Cross...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Archives of Public Health |
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| Online Access: | https://doi.org/10.1186/s13690-023-01095-2 |
| _version_ | 1797832260826693632 |
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| author | Robert J. Romanelli Rivfka Shenoy Meghan C. Martinez Satish Mudiganti Louis T. Mariano Kyle A. Zanocco Zachary Wagner Allison Kirkegaard Katherine E. Watkins |
| author_facet | Robert J. Romanelli Rivfka Shenoy Meghan C. Martinez Satish Mudiganti Louis T. Mariano Kyle A. Zanocco Zachary Wagner Allison Kirkegaard Katherine E. Watkins |
| author_sort | Robert J. Romanelli |
| collection | DOAJ |
| description | Abstract Objectives To examine racial and ethnic disparities in postoperative opioid prescribing. Data sources Electronic health records (EHR) data across 24 hospitals from a healthcare delivery system in Northern California from January 1, 2015 to February 2, 2020 (study period). Study design Cross-sectional, secondary data analyses were conducted to examine differences by race and ethnicity in opioid prescribing, measured as morphine milligram equivalents (MME), among patients who underwent select, but commonly performed, surgical procedures. Linear regression models included adjustment for factors that would likely influence prescribing decisions and race and ethnicity-specific propensity weights. Opioid prescribing, overall and by race and ethnicity, was also compared to postoperative opioid guidelines. Data extraction Data were extracted from the EHR on adult patients undergoing a procedure during the study period, discharged to home with an opioid prescription. Principal findings Among 61,564 patients, on adjusted regression analysis, non-Hispanic Black (NHB) patients received prescriptions with higher mean MME than non-Hispanic white (NHW) patients (+ 6.4% [95% confidence interval: 4.4%, 8.3%]), whereas Hispanic and non-Hispanic Asian patients received lower mean MME (-4.2% [-5.1%, -3.2%] and − 3.6% [-4.8%, -2.3%], respectively). Nevertheless, 72.8% of all patients received prescriptions above guidelines, ranging from 71.0 to 80.3% by race and ethnicity. Disparities in prescribing were eliminated among Hispanic and NHB patients versus NHW patients when prescriptions were written within guideline recommendations. Conclusions Racial and ethnic disparities in opioid prescribing exist in the postoperative setting, yet all groups received prescriptions above guideline recommendations. Policies encouraging guideline-based prescribing may reduce disparities and overall excess prescribing. |
| first_indexed | 2024-04-09T14:04:58Z |
| format | Article |
| id | doaj.art-f148be0f34c34c65b910d1d4fc0e9d43 |
| institution | Directory Open Access Journal |
| issn | 2049-3258 |
| language | English |
| last_indexed | 2024-04-09T14:04:58Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Archives of Public Health |
| spelling | doaj.art-f148be0f34c34c65b910d1d4fc0e9d432023-05-07T11:06:21ZengBMCArchives of Public Health2049-32582023-05-0181111110.1186/s13690-023-01095-2Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020Robert J. Romanelli0Rivfka Shenoy1Meghan C. Martinez2Satish Mudiganti3Louis T. Mariano4Kyle A. Zanocco5Zachary Wagner6Allison Kirkegaard7Katherine E. Watkins8RAND EuropeUniversity of CaliforniaSutter Health, Center for Health Services Research—Palo Alto and Walnut CreekSutter Health, Center for Health Services Research—Palo Alto and Walnut CreekRAND Corporation—Santa MonicaUniversity of CaliforniaRAND Corporation—Santa MonicaRAND Corporation—Santa MonicaRAND Corporation—Santa MonicaAbstract Objectives To examine racial and ethnic disparities in postoperative opioid prescribing. Data sources Electronic health records (EHR) data across 24 hospitals from a healthcare delivery system in Northern California from January 1, 2015 to February 2, 2020 (study period). Study design Cross-sectional, secondary data analyses were conducted to examine differences by race and ethnicity in opioid prescribing, measured as morphine milligram equivalents (MME), among patients who underwent select, but commonly performed, surgical procedures. Linear regression models included adjustment for factors that would likely influence prescribing decisions and race and ethnicity-specific propensity weights. Opioid prescribing, overall and by race and ethnicity, was also compared to postoperative opioid guidelines. Data extraction Data were extracted from the EHR on adult patients undergoing a procedure during the study period, discharged to home with an opioid prescription. Principal findings Among 61,564 patients, on adjusted regression analysis, non-Hispanic Black (NHB) patients received prescriptions with higher mean MME than non-Hispanic white (NHW) patients (+ 6.4% [95% confidence interval: 4.4%, 8.3%]), whereas Hispanic and non-Hispanic Asian patients received lower mean MME (-4.2% [-5.1%, -3.2%] and − 3.6% [-4.8%, -2.3%], respectively). Nevertheless, 72.8% of all patients received prescriptions above guidelines, ranging from 71.0 to 80.3% by race and ethnicity. Disparities in prescribing were eliminated among Hispanic and NHB patients versus NHW patients when prescriptions were written within guideline recommendations. Conclusions Racial and ethnic disparities in opioid prescribing exist in the postoperative setting, yet all groups received prescriptions above guideline recommendations. Policies encouraging guideline-based prescribing may reduce disparities and overall excess prescribing.https://doi.org/10.1186/s13690-023-01095-2OpioidsPrescriptionsSurgeryHealth care disparitiesElectronic health records |
| spellingShingle | Robert J. Romanelli Rivfka Shenoy Meghan C. Martinez Satish Mudiganti Louis T. Mariano Kyle A. Zanocco Zachary Wagner Allison Kirkegaard Katherine E. Watkins Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020 Archives of Public Health Opioids Prescriptions Surgery Health care disparities Electronic health records |
| title | Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020 |
| title_full | Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020 |
| title_fullStr | Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020 |
| title_full_unstemmed | Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020 |
| title_short | Disparities in postoperative opioid prescribing by race and ethnicity: an electronic health records-based observational study from Northern California, 2015–2020 |
| title_sort | disparities in postoperative opioid prescribing by race and ethnicity an electronic health records based observational study from northern california 2015 2020 |
| topic | Opioids Prescriptions Surgery Health care disparities Electronic health records |
| url | https://doi.org/10.1186/s13690-023-01095-2 |
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