Racial and Ethnic Disparities in Opioid Prescribing on Hospital Discharge Among Older Adults: A National Retrospective Cohort Study

Koushik Kasanagottu; Timothy S Anderson; Shrunjal Trivedi; Long H Ngo; Jeffrey L Schnipper; Ellen P McCarthy; Shoshana J Herzig

doi:10.1007/s11606-024-08687-w

Racial and Ethnic Disparities in Opioid Prescribing on Hospital Discharge Among Older Adults: A National Retrospective Cohort Study

J Gen Intern Med. 2024 Feb 29. doi: 10.1007/s11606-024-08687-w. Online ahead of print.

Authors

Koushik Kasanagottu^{1

2}, Timothy S Anderson^{3

4}, Shrunjal Trivedi³, Long H Ngo^{3

4}, Jeffrey L Schnipper^{4

5}, Ellen P McCarthy^{3

4

6}, Shoshana J Herzig^{3

4}

Affiliations

¹ Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02246, USA. koushkasana@gmail.com.
² Department of Medicine, Harvard Medical School, Boston, MA, USA. koushkasana@gmail.com.
³ Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02246, USA.
⁴ Department of Medicine, Harvard Medical School, Boston, MA, USA.
⁵ Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
⁶ Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.

PMID: 38424348
DOI: 10.1007/s11606-024-08687-w

Abstract

Background: Disparities in opioid prescribing among racial and ethnic groups have been observed in outpatient and emergency department settings, but it is unknown whether similar disparities exist at discharge among hospitalized older adults.

Objective: To determine filled opioid prescription rates on hospital discharge by race/ethnicity among Medicare beneficiaries.

Design: Retrospective cohort study.

Participants: Medicare beneficiaries 65 years or older discharged from hospital in 2016, without opioid fills in the 90 days prior to hospitalization (opioid-naïve).

Main measures: Race/ethnicity was categorized by the Research Triangle Institute (RTI), grouped as Asian/Pacific Islander, Black, Hispanic, other (American Indian/Alaska Native/unknown/other), and White. The primary outcome was an opioid prescription claim within 2 days of hospital discharge. The secondary outcome was total morphine milligram equivalents (MMEs) among adults with a filled opioid prescription.

Key results: Among 316,039 previously opioid-naïve beneficiaries (mean age, 76.8 years; 56.2% female), 49,131 (15.5%) filled an opioid prescription within 2 days of hospital discharge. After adjustment, Black beneficiaries were 6% less likely (relative risk [RR] 0.94, 95% CI 0.91-0.97) and Asian/Pacific Islander beneficiaries were 9% more likely (RR 1.09, 95% CI 1.03-1.14) to have filled an opioid prescription when compared to White beneficiaries. Among beneficiaries with a filled opioid prescription, mean total MMEs were lower among Black (356.9; adjusted difference - 4%, 95% CI - 7 to - 1%), Hispanic (327.0; adjusted difference - 7%, 95% CI - 10 to - 4%), and Asian/Pacific Islander (328.2; adjusted difference - 8%, 95% CI - 12 to - 4%) beneficiaries when compared to White beneficiaries (409.7).

Conclusions and relevance: Black older adults were less likely to fill a new opioid prescription after hospital discharge when compared to White older adults and received lower total MMEs. The factors contributing to these differential prescribing patterns should be investigated further.

Keywords: care transitions; geriatrics; opioid prescribing disparities; pain management.

Abstract

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