Are There Sex Disparities in ED Opioid Prescribing for Sickle Cell Disease?

There is evidence of a trend signaling that men with sickle cell disease may be more likely than women be prescribed an opioid in the emergency department.

Although a nationally representative sample of emergency department (ED) visits among patients with sickle cell disease (SCD) showed no conclusive evidence of sex-based disparity in opioid prescribing, there is evidence of a trend signaling that men with SCD may be more likely than women with SCD to be prescribed an opioid, according to a brief report published in the American Journal of Emergency Medicine.

Acute vaso-occlusive crisis pain is one of the leading reasons patients with SCD visit the ED, according to researchers. Prior studies have suggested that men and women receive disparate treatment for acute pain in EDs. This cross-sectional study was designed to determine possible sex differences in analgesic use among patients with SCD who present to the ED with acute pain. Investigators analyzed the 2006-2015 public-use datasets of the National Hospital Ambulatory Medical Care Survey (NHAMCS) ED sample. They identified 644 SCD ED visits, representing an estimated 2,688,349 ED visits with a primary SCD diagnosis.

Between 2006 and 2015, no significant change in the number of opioids provided through the ED was seen, nor were there any apparent sex disparities. Approximately 48.3% (95% CI, 42.0-54.6) of all ED visits for SCD included documented opioids.

After adjusting for age, reason for visit, insurance status, region, race, and pain score, men were prescribed opioids 1.5 times more often than were women (95% CI, 0.8-2.8).

Although men had a higher average pain score than women, this difference was not significant (8.1 [95% CI, 7.7-8.7] vs 7.4 [95% CI, 6.7-8.1]).

Study investigators concluded, “Overall, we did not find conclusive evidence of disparities in opioid prescribing though evidence of a trend signaling that male patient with SCD were more likely than female patients to be prescribed an opioid.” They also noted that “the characteristics of the sample may have limited our ability to detect statistically significant differences.”


Wilson TT, Chou SC, Becker S, Schuur JD, Beaudoin F. Evaluation of sex disparities in opioid use among ED patients with sickle cell disease, 2006-2015 [published online September 221, 2021]. Am J Emerg Med. doi: 10.1016/j.ajem.2021.09.023