Health Equity/Community Health
Poster Session 4
.jpg "Mariana Espinal, MD (she/her/hers) photo")
Mariana Espinal, MD (she/her/hers)
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Bethesda, MD, United States
Hyagriv Simhan, MD
Professor
University of Pittsburgh
Pittsburgh, PA, United States
To evaluate whether there are racial and ethnic disparities in post-cesarean delivery (CD) inpatient opioid administration and, among participants assigned to an individualized opioid prescription protocol (IOPP), discharge opioid prescribing and pain experience.
Secondary analysis of a multicenter trial of participants post-CD randomly assigned to an IOPP or fixed quantity of opioids upon discharge. We included participants who self-reported as non-Hispanic White (NHW), non-Hispanic Black (NHB), or Hispanic. The primary outcome was morphine milligram equivalents (MMEs) used in 24 hours prior to randomization (all participants). Secondary outcomes (IOPP participants) were number of tablets recommended (based on MMEs use in 24 hours prior to randomization) and requested, and pain experience outcomes at 1-week post-discharge. Outcomes were compared by race and ethnicity using bivariable and multivariable analyses.
Of 5464 individuals, 43% identified as NHW, 28% NHB, and 21% Hispanic. Pain score prior to randomization was similar among groups (median 7). MMEs used in 24 hours prior to randomization was higher in NHB and lower in Hispanic vs. NHW individuals (Table). In adjusted analyses, MME use was lower for Hispanic participants (median difference -8.3, CI [-10.2, -6.3]) but similar for NHB (median difference 1.1, CI [-1.8, 4.0]) vs. NHW participants. Hispanic IOPP participants were recommended and requested fewer tablets and were less likely to request an opioid prescription after discharge. In contrast, NHB IOPP participants were more likely to request an opioid prescription after discharge, more likely to have pain and pain interference scores ≥4 on Brief Pain Inventory, and less likely to report improved global impression of change with treatment.
Race and ethnicity were associated with post-CD inpatient opioid administration and post-discharge pain experiences. Contrary to prior literature, NHB participants used similar MMEs post-CD and were more likely to request an opioid prescription after discharge, yet still had poorer pain experience-related outcomes.