Prescribing Patterns in Emergency Department May Be Affected by Race, Sex

Emergency room waiting area
Emergency room waiting area
Patients' race/ethnicity and sex may have an effect on prescribing patterns for opioid and nonopioid medications.

Patients’ race/ethnicity and sex may have an effect on prescribing patterns for opioid and nonopioid medications, according to a retrospective study published in Anesthesia Analgesia.

Patient data from the 2010 to 2014 Center for Disease Control-National Hospital Ambulatory Medical Care Survey were used to retrospectively examine opioid prescribing patterns for patients presenting with primary appendicitis or gallbladder disease diagnoses. The receipt of opioid medication was the study’s primary outcome; receipt of nonopioid medications and antiemetic medications, time spent waiting to see a provider, and time spent in the emergency department were all secondary outcomes. The analysis of the association between sex and analgesic receipt between Caucasian non-Hispanic and non-Caucasian patients was adjusted on the basis of multiple variables, including age, city vs noncity residence, presence of comorbidities, time of visit, and geographic region within the United States.

A total of 2,622,926 unique emergency department visits were identified from a weighted sample of 553 patients. Compared with Caucasians, non-Caucasian men were prescribed fewer opioid medications (odds ratio [OR], 0.72; 95% CI, 0.72-0.73; P <.001). In this cohort, non-Caucasian women were prescribed more opioids compared with Caucasian women (OR, 1.31; 95% CI, 1.30-1.32; P <.001). In addition, nonopioid medications were more likely to be prescribed to non-Caucasian men compared with Caucasian men (OR, 1.38; 95%, CI 1.36-1.40; P <.001), and non-Caucasian women were given fewer nonopioids compared with Caucasian women (OR, 0.91; 95% CI, 0.90-0.91; P <.001).

Overall, non-Caucasian men and women received more antiemetics compared with their Caucasian counterparts (men: OR, 1.12 [95% CI, 1.11-1.13, P <.001]; women: OR, 1.45 [95% CI, 1.44-1.46; P <.001]). In addition, non-Caucasians with private insurance were more likely to receive opioid medications than Caucasians with private insurance (OR, 1.64; 95% CI, 1.63-1.67; P <.001), and non-Caucasians without private insurance were found to receive fewer opioids than Caucasians without private insurance (OR, 0.79; 95% CI, 0.79-0.80; P <.001).

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The chances of receiving opioid medications decreased for non-Caucasians with advancing age, whereas the opposite was found for Caucasians. No differences were found between race/ethnicities or sexes with regard to the time spent seeing a provider or length of stay.

A limitation of this study is the lack of data on patients’ chronic use of opioid medications and primary language, which may have affected opioid prescribing practices. In addition, the study examined patients with surgical diagnoses of appendicitis and gallbladder disease, and may not be generalizable to a wider population.

“We have documented an imbalance in opioid and nonopioid administration to patients with appendicitis or gallbladder disease: males are less likely to receive analgesics than females, non-Caucasian females are the most likely to receive opioids as compared to other groups, and non-Caucasian males are the least likely to receive opioids,” concluded the study authors.

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Rosenbloom JM, Burns SM, Kim E, et al. Race/ethnicity and sex both affect opioid administration in the emergency room [published online May 31, 2018]. Anesth Analg. doi: 10.1213/ANE.0000000000003517