Skip to main content

Advertisement

SpringerLink
Log in

Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

This study examined the association between race/ethnicity and health insurance payer type with pediatric opioid and non-opioid ordering in an inpatient hospital setting.

Methods

Cross-sectional inpatient encounter data from June 2013 to June 2018 was retrieved from a pediatric children’s hospital in Southern California (N = 55,944), and statistical analyses were performed to determine associations with opioid ordering.

Results

There was a significant main effect of race/ethnicity on opioid and non-opioid orders. Physicians ordered significantly fewer opioid medications, but a greater number of non-opioid medications, for non-Hispanic African American children than non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic White pediatric patients. There was also a main effect of health insurance payer type on non-opioid orders. Patients with government-sponsored plans (e.g., Medi-Cal, Medicare) received fewer non-opioid prescriptions compared with patients with both HMO and PPO coverage. Additionally, there was a significant race/ethnicity by insurance interaction on opioid orders. Non-Hispanic White patients with “other” insurance coverage received the greatest number of opioid orders. In non-Hispanic African American patients, children with PPO coverage received fewer opioids than those with government-sponsored and HMO insurance. For non-Hispanic Asian patients, children with PPO were prescribed more opioids than those with government-sponsored and HMO coverage.

Conclusion

Findings suggest that the relationship between race/ethnicity, insurance type, and physician decisions opioid prescribing is complex and multifaceted. Given that consistency in opioid prescribing should be seen regardless of patient background characteristics, future studies should continue to assess and monitor unequitable differences in care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jones MR, Novitch MB, Sarrafpour S, Ehrhardt KP, Scott BB, Orhurhu V, et al. Government legislation in response to the opioid epidemic. Curr Pain Headache Rep. 2019;23(6):40. https://doi.org/10.1007/s11916-019-0781-1.

    Article  PubMed  Google Scholar 

  2. Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309(7):657–9.

    Article  CAS  Google Scholar 

  3. Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-assisted therapies: tackling the opioid-overdose epidemic. N Engl J Med. 2014;370(22):2063–6. https://doi.org/10.1056/NEJMp1404181.

    Article  CAS  PubMed  Google Scholar 

  4. Lyden J, Binswanger IA. The United States opioid epidemic. Semin Perinatol. 2019;43(3):123–31. https://doi.org/10.1053/j.semperi.2019.01.001.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012. JAMA Pediatr. 2016;170(12):1195–201. https://doi.org/10.1001/jamapediatrics.2016.2154.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gaither JR, Shabanova V, Leventhal JM. US National Trends in pediatric deaths from prescription and illicit opioids, 1999-2016. JAMA Netw Open. 2018;1(8):e186558. https://doi.org/10.1001/jamanetworkopen.2018.6558.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tomaszewski DM, Arbuckle C, Yang S, Linstead E. Trends in opioid use in pediatric patients in US emergency departments from 2006 to 2015. JAMA Netw Open. 2018;1(8):e186161. https://doi.org/10.1001/jamanetworkopen.2018.6161.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ahrnsbrak R, Bose J, Hedden SL, Lipari RN, Park-Lee E. Key substance use and mental health indicators in the United States: results from the 2016 National Survey on drug use and health. Substance Abuse and Mental Health Services Administration. Published September 2017. https://www.samhsa.gov/data/

  9. McCabe SE, West BT, Veliz P, McCabe VV, Stoddard SA, Boyd CJ. Trends in medical and nonmedical use of prescription opioids among US adolescents. Pediatrics. 2017;139(4):e20162387.

    Article  Google Scholar 

  10. Miech R, Johnston L, O’Malley PM, Keyes KM, Heard K. Prescription opioids in adolescence and future opioid misuse. PEDIATRICS. 2015;136(5):1169–77. https://doi.org/10.1542/peds.2015-1364.

    Article  Google Scholar 

  11. Harbaugh CM, Lee JS, Hu HM, McCabe SE, Voepel-Lewis T, Englesbe MJ, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018;141(1):e20172439. https://doi.org/10.1542/peds.2017-2439.

    Article  PubMed  Google Scholar 

  12. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–45. https://doi.org/10.1001/jama.2016.1464.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Zhu A, Benzon HA, Anderson TA. Evidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populations: a systematic review. Anesth Analg. 2017;125(5):1569–87. https://doi.org/10.1213/ANE.0000000000002434.

    Article  CAS  PubMed  Google Scholar 

  14. Wong I, St John-Green C, Walker SM. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) in children. Lonnqvist P-A, ed. Paediatr Anaesth 2013;23(6):475–495. doi:https://doi.org/10.1111/pan.12163.

  15. Schug SA. The role of COX-2 inhibitors in the treatment of postoperative pain. J Cardiovasc Pharmacol. 2006;47(Supplement 1):S82–6. https://doi.org/10.1097/00005344-200605001-00015.

    Article  CAS  PubMed  Google Scholar 

  16. Yang J, Bauer BA, Wahner-Roedler DL, Chon TY, Xiao L. The modified WHO analgesic ladder: is it appropriate for chronic non-cancer pain? JPR. 2020;13:411–7. https://doi.org/10.2147/JPR.S244173.

    Article  Google Scholar 

  17. Edlund MJ, Martin BC, Russo JE, Devries A, Braden JB, Sullivan MD. The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic non-cancer pain: the role of opioid prescription. Clin J Pain. 2014;30(7):557–64. https://doi.org/10.1097/AJP.0000000000000021.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Anderson KO, Green CR, Payne R. Racial and ethnic disparities in pain: causes and consequences of unequal care. J Pain. 2009;10(12):1187–204. https://doi.org/10.1016/j.jpain.2009.10.002.

    Article  PubMed  Google Scholar 

  19. Tamayo-Sarver JH, Hinze SW, Cydulka RK, Baker DW. Racial and ethnic disparities in emergency department analgesic prescription. Am J Public Health. 2003;93(12):2067–73. https://doi.org/10.2105/AJPH.93.12.2067.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299(1):70–8. https://doi.org/10.1001/jama.2007.64.

    Article  CAS  PubMed  Google Scholar 

  21. Singhal A, Tien Y-Y, Hsia RY. Racial-ethnic disparities in opioid prescriptions at emergency department visits for conditions commonly associated with prescription drug abuse. In: Seedat S, editor. PLoS ONE, vol. 11; 2016. p. e0159224. https://doi.org/10.1371/journal.pone.0159224.

    Chapter  Google Scholar 

  22. Dickason RM, Chauhan V, Mor A, Ibler E, Kuehnle S, Mahoney D, et al. Racial differences in opiate administration for pain relief at an academic emergency department. WestJEM. 2015;16(3):372–80. https://doi.org/10.5811/westjem.2015.3.23893.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169(11):996–1002. https://doi.org/10.1001/jamapediatrics.2015.1915.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Jimenez N, Seidel K, Martin LD, Rivara FP, Lynn AM. Perioperative analgesic treatment in Latino and non-Latino pediatric patients. J Health Care Poor Underserved. 2010;21(1):229–36. https://doi.org/10.1353/hpu.0.0236.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sadhasivam S, Chidambaran V, Ngamprasertwong P, Esslinger HR, Prows C, Zhang X, et al. Race and unequal burden of perioperative pain and opioid related adverse effects in children. PEDIATRICS. 2012;129(5):832–8. https://doi.org/10.1542/peds.2011-2607.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM. Controlled substance prescribing patterns — prescription behavior surveillance system, Eight States, 2013. MMWR Surveill Summ. 2015;64(9):1–14. https://doi.org/10.15585/mmwr.ss6409a1.

    Article  PubMed  Google Scholar 

  27. Benefits.gov. California Medicaid. Benefits.gov. Accessed September 8, 2020. https://www.benefits.gov/benefit/1620

  28. Arpey NC, Gaglioti AH, Rosenbaum ME. How socioeconomic status affects patient perceptions of health care: a qualitative study. J Prim Care Community Health. 2017;8(3):169–75. https://doi.org/10.1177/2150131917697439.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Becker G, Newsom E. Socioeconomic status and dissatisfaction with health care among chronically ill African Americans. Am J Public Health. 2003;93(5):742–8. https://doi.org/10.2105/AJPH.93.5.742.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Waldrop LD, King JJ, Mayfield J, et al. The effect of lower socioeconomic status insurance on outcomes after primary shoulder arthroplasty. J Shoulder Elb Surg. 2018;27(6):S35–42. https://doi.org/10.1016/j.jse.2018.01.002.

    Article  Google Scholar 

  31. Huttin C. The role of different types of health insurance on access and utilization of antihypertensive drugs: an empirical study in a US hypertensive population. Dis Manag Health Out. 2002;10(7):419–30. https://doi.org/10.2165/00115677-200210070-00003.

    Article  Google Scholar 

  32. Ehwerhemuepha L, Gasperino G, Bischoff N, Taraman S, Chang A, Feaster W. HealtheDataLab – a cloud computing solution for data science and advanced analytics in healthcare with application to predicting multi-center pediatric readmissions. BMC Med Inform Decis Mak. 2020;20(1):1–12. https://doi.org/10.1186/s12911-020-01153-7.

    Article  Google Scholar 

  33. Chung CP, Callahan ST, Cooper WO, Dupont WD, Murray KT, Franklin AD, et al. Outpatient opioid prescriptions for children and opioid-related adverse events. Pediatrics. 2018;142(2):e20172156. https://doi.org/10.1542/peds.2017-2156.

    Article  PubMed  Google Scholar 

  34. Richardson LP, Fan MY, McCarty CA, et al. Trends in the prescription of opioids for adolescents with non-cancer pain. Gen Hosp Psychiatry. 2011;33(5):423–8. https://doi.org/10.1016/j.genhosppsych.2011.04.009.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ehwerhemuepha L, Schultz S, Feaster W. Clinical and psychosocial factors associated with patient experience in pediatrics. Clin Pediatr (Phila). 2018;57(8):937–44. https://doi.org/10.1177/0009922817737078.

    Article  Google Scholar 

  36. Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the face, legs, activity, cry, consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg. 2002;95(5):1224–9. https://doi.org/10.1097/00000539-200211000-00020.

    Article  PubMed  Google Scholar 

  37. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The faces pain scale – revised: toward a common metric in pediatric pain measurement. Pain. 2001;93(2):173–83. https://doi.org/10.1016/S0304-3959(01)00314-1.

    Article  PubMed  Google Scholar 

  38. Miró J, Castarlenas E, Huguet A. Evidence for the use of a numerical rating scale to assess the intensity of pediatric pain. Eur J Pain. 2009;13(10):1089–95. https://doi.org/10.1016/j.ejpain.2009.07.002.

    Article  PubMed  Google Scholar 

  39. Hummel P, Puchalski M, Creech SD, Weiss MG. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol. 2008;28:55–60. https://doi.org/10.1097/00000539-200211000-00020.

    Article  CAS  PubMed  Google Scholar 

  40. Sills MR, Hall M, Cutler GJ, Colvin JD, Gottlieb LM, Macy ML, et al. Adding social determinant data changes children’s hospitals’ readmissions performance. J Pediatr. 2017;186:150–7.

    Article  Google Scholar 

  41. Ehwerhemuepha L, Finn S, Rothman M, Rakovski C, Feaster W. A novel model for enhanced prediction and understanding of unplanned 30-day pediatric readmission. Hosp Pediatr. 2018;8(9):578–87. https://doi.org/10.1542/hpeds.2017-0220.

    Article  PubMed  Google Scholar 

  42. Ehwerhemuepha L, Pugh K, Grant A, Taraman S, Chang A, Rakovski C, et al. A statistical-learning model for unplanned 7-day readmission in pediatrics. Hosp Pediatr. 2020;10(1):43–51.

    Article  Google Scholar 

  43. Delaplain PT, Guner YS, Feaster W, Gholizadeh M, Reyna T, Ehwerhemuepha L. Prediction of 7-day readmission risk for pediatric trauma patients. J Surg Res. 2020;253:254–61.

    Article  Google Scholar 

  44. Meyers LS, Gamst GC, Guarino AJ. Applied multivariate research: design and interpretation. 2nd ed. Sage Publications, Inc; 2013.

  45. Kolodny A, Courtwright DT, Hwang CS, Kreiner P, Eadie JL, Clark TW, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36(1):559–74. https://doi.org/10.1146/annurev-publhealth-031914-122957.

    Article  PubMed  Google Scholar 

  46. Bonar EE, Coughlin L, Roche JS, Philyaw-Kotov ML, Bixler EA, Sinelnikov S, et al. Prescription opioid misuse among adolescents and emerging adults in the United States: a scoping review. Prev Med. 2020;132:105972. https://doi.org/10.1016/j.ypmed.2019.105972.

    Article  PubMed  PubMed Central  Google Scholar 

  47. McCabe SE, Veliz P, Schulenberg JE. Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: a national longitudinal study. PAIN. 2016;157(10):2173–8. https://doi.org/10.1097/j.pain.0000000000000624.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Edwards RR, Fillingim RB. Ethnic differences in thermal pain responses. Psychosom Med. 1999;61(3):346–54. https://doi.org/10.1097/00006842-199905000-00014.

    Article  CAS  PubMed  Google Scholar 

  49. Campbell CM, Edwards RR, Fillingim RB. Ethnic differences in responses to multiple experimental pain stimuli. Pain. 2005;113(1):20–6. https://doi.org/10.1016/j.pain.2004.08.013.

    Article  PubMed  Google Scholar 

  50. Fortier MA, Anderson CT, Kain ZN. Ethnicity matters in the assessment and treatment of children’s pain. Pediatrics. 2009;124(1):378–80.

    Article  Google Scholar 

  51. Donaldson CD, Nakawaki B, Crano WD. Variations in parental monitoring and predictions of adolescent prescription opioid and stimulant misuse. Addict Behav. 2015;45:14–21. https://doi.org/10.1016/j.addbeh.2015.01.022.

    Article  PubMed  PubMed Central  Google Scholar 

  52. United States Census Bureau. U.S. Census Bureau QuickFacts: California . Retrieved from https://www.census.gov/quickfacts/CA

  53. Tait RC, Chibnall JT, Kalauokalani D. Provider judgments of patients in pain: seeking symptom certainty. Pain Med. 2009;10(1):11–34. https://doi.org/10.1111/j.1526-4637.2008.00527.x.

    Article  PubMed  Google Scholar 

  54. Blair IV, Havranek EP, Price DW, Hanratty R, Fairclough DL, Farley T, et al. Assessment of biases against Latinos and African Americans among primary care providers and community members. Am J Public Health. 2013;103(1):92–8. https://doi.org/10.2105/AJPH.2012.300812.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Street RL Jr, Gordon HS, Ward MM, Krupat E, Kravitz RL. Patient participation in medical consultations: why some patients are more involved than others. Med Care. 2005;43(10):960–9.

    Article  Google Scholar 

  56. Mossey JM. Defining racial and ethnic disparities in pain management. Clin Orthop Relat Res. 2011;469(7):1859–70. https://doi.org/10.1007/s11999-011-1770-9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the Kay Family Foundation for their generous support of this work.

Funding

This project was supported by the Kay Family Foundation Data Analytics grant at Chapman University.

Author information

Authors and Affiliations

  1. Department of Information Systems, Children’s Hospital of Orange County, CA, 92868, Orange, USA

    Louis Ehwerhemuepha & William Feaster

  2. Department of Psychology, Chapman University, Orange, CA, 92866, USA

    Candice D. Donaldson, Vivian Luong & Brooke N. Jenkins

  3. Center on Stress & Health, University of California Irvine, Orange, CA, 92868, USA

    Candice D. Donaldson, Zeev N. Kain, Vivian Luong, Michelle A. Fortier & Brooke N. Jenkins

  4. Department of Anesthesiology and Perioperative Care, University of California Irvine, Irvine, CA, 92697, USA

    Zeev N. Kain & Brooke N. Jenkins

  5. Children’s Hospital of Orange County, Orange, CA, 92868, USA

    Zeev N. Kain & Michelle A. Fortier

  6. Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, 92697, USA

    Michelle A. Fortier

  7. Population Health, Children’s Hospital of Orange County, Orange, CA, 92868, USA

    Michael Weiss

  8. School of Pharmacy Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90089, USA

    Daniel Tomaszewski

  9. School of Pharmacy, Department of Pharmacy Practice, Chapman University, Orange, CA, 92868, USA

    Sun Yang

  10. School of Pharmacy, Department of Biomedical and Pharmaceutical Sciences, Chapman University, Orange, CA, 92868, USA

    Michael Phan

Authors
  1. Louis Ehwerhemuepha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Candice D. Donaldson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zeev N. Kain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vivian Luong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michelle A. Fortier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William Feaster
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel Tomaszewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Phan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Brooke N. Jenkins
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Louis Ehwerhemuepha: This author contributed to the conception and design of the study and acquisition of the data and reviewed and revised the article for intellectual content and drafted the discussion.

Dr. Candice D. Donaldson: This author conducted the statistical analysis, drafted the method and results, and reviewed and revised the article for intellectual content.

Dr. Zeev N. Kain: This author contributed to the interpretation of data and reviewed and revised the article for intellectual content.

Ms. Vivian Luong: This author drafted the introduction and reviewed and revised the manuscript for intellectual content.

Dr. Michelle A. Fortier: This author contributed to the interpretation of data and reviewed and revised the article for intellectual content.

Dr. William Feaster: This author contributed to the interpretation of data and reviewed and revised the article for intellectual content.

Dr. Michael Weiss: This author contributed to the interpretation of data and reviewed and revised the article for intellectual content.

Dr. Daniel Tomaszewski: This author contributed to the interpretation of data and reviewed and revised the article for intellectual content.

Dr. Sun Yang: This author contributed to the interpretation of data and reviewed and revised the article for intellectual content.

Dr. Michael Phan: This author contributed to the interpretation of data and reviewed and revised the article for intellectual content.

Dr. Brooke N. Jenkins: This author contributed to the conception and design of the study and acquisition of the data and reviewed and revised the article for intellectual content.

All figures were created on Microsoft Excel and reviewed by all authors.

Corresponding author

Correspondence to Brooke N. Jenkins.

Ethics declarations

Conflict of Interest

Dr. Zeev N. Kain is a speaker for Covidien and a member of Edwards Life Sciences and Huron Consulting.

Code Availability

Not applicable.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ehwerhemuepha, L., Donaldson, C.D., Kain, Z.N. et al. Race, Ethnicity, and Insurance: the Association with Opioid Use in a Pediatric Hospital Setting. J. Racial and Ethnic Health Disparities 8, 1232–1241 (2021). https://doi.org/10.1007/s40615-020-00882-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-020-00882-9

Keywords

Search

Navigation