The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States
Open accessAbstract
Background Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described, yet the influence of socioeconomic status (SES) remains unclear. Objectives (1) To examine the effect of neighborhood SES on the prescribing of opioids for moderate to severe pain; and (2) to determine if racial disparities in opioid prescribing persist after accounting for SES. Design We used cross-sectional data from the National Hospital Ambulatory Medical Care Survey between 2006 and 2009 to examine the prescribing of opioids to patients presenting with moderate to severe pain (184 million visits). We used logistic regression to examine the association between the prescribing of opioids, SES, and race. Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region. Main measures Our primary outcome measure was whether an opioid was prescribed during a visit for moderate to severe pain. SES was determined based on income, percent poverty, and educational level within a patient's zip code. Results Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P<0.001), and educational level (46.3 % vs. 42.5 %, P=0.01). Black patients were prescribed opioids less frequently than white patients across all measures of SES. In adjusted models, black patients (AOR 0.73; 95 % CI 0.66–0.81) and patients from poorer areas (AOR 0.76; 95 % CI 0.68–0.86) were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates. Conclusions Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas. Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.
AI snapshot
Written from the paper’s full text.
TL;DR
In NHAMCS 2006–2009, ED patients with moderate-to-severe pain from lower-SES neighborhoods were less likely to receive opioids than those from more affluent neighborhoods. Black and Hispanic patients were also less likely to receive opioids than white and non-Hispanic patients, and these disparities persisted after adjustment for neighborhood SES.
Key findings
- Opioid prescribing was lower in the lowest vs highest SES quartiles: poverty 39.4% vs 49.0% (P<0.001), income 40.7% vs 47.3% (P<0.001), and education 42.5% vs 46.3% (P=0.01).
- In adjusted models, patients in high-poverty areas (>20% poverty) were less likely to receive opioids than those in low-poverty areas (<5%): AOR 0.76, 95% CI 0.68–0.84.
- Black patients received opioids less often than white patients (38.7% vs 46.4%, P<0.001); adjusted models accounting for SES showed lower odds (poverty AOR 0.73, 95% CI 0.67–0.80; income AOR 0.71, 95% CI 0.65–0.78; education AOR 0.69, 95% CI 0.63–0.76).
- Hispanic patients received opioids less often than non-Hispanic patients (40.4% vs 44.9%, P<0.001); adjusted AORs were 0.83 (0.75–0.91) for poverty, 0.83 (0.74–0.88) for income, and 0.80 (0.73–0.88) for education. No trend in opioid prescribing by race was found from 2006 to 2009.
Methods
- Cross-sectional analysis of National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2006–2009, including adults ≥18 presenting to EDs with moderate-to-severe pain; weighted to national estimates (abstract reports 184 million visits).
- Primary outcome: whether an opioid was prescribed. Neighborhood SES was measured by zip-code quartiles for poverty, median household income, and education; race was white/black/other and ethnicity Hispanic/non-Hispanic.
- Logistic regression models, weighted for complex sampling, with separate models for each SES measure and adjustment for age, sex, pain severity, injury status, prior ED visits, hospital type, region, and metropolitan status.
Limitations
- Stated: SES was defined only by five-digit zip code, so patient-level SES beyond neighborhood quartiles was unavailable; sample size did not allow examining Asian or other racial groups separately; quantity and strength of opioids were not available; clinician race/ethnicity, institutional/prescriber factors, and use of testing or prescription monitoring were not accounted for.
- Stated: SES was missing for approximately 5.7% of visits, and those visits were excluded.
- Evident: the cross-sectional observational design cannot establish causality and may leave residual confounding.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 3 cited sources checked · 0 supported · 0 flagged
- Findingown data
In adjusted models, black patients were less likely to receive opioids compared to white patients while accounting for percent poverty, median household income, and education level (AORs 0.79-0.81).
“In adjusted models, black patients were less frequently prescribed opioids compared to white patients while accounting for percent poverty (AOR=0.81,0.68-0.97),median household income (AOR=0.80,0.66-0.96),and education level (AOR=0.79,0.66-0.95)(Table 2).”
Quote in the paperSubstantial claim - Findingown data
Among ED visits for moderate to severe pain, opioid prescribing was more frequent for patients in the highest household income quartile (> $52,388) than for those in the lowest income quartile ($32,793 or less) (47.3% vs 40.7%, P<0.001).
“Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3 % vs. 42.5 %, P=0.01).”
Quote in the paperSubstantial claim - Findingown data
Prescribing patterns varied according to geographic region.
“We also found that prescribing patterns varied according to geographic region”
Quote in the paperNot a substantial claim - Findingown data
In adjusted models, neighborhood socioeconomic status was an independent predictor of opioid prescribing for moderate to severe pain.
“In adjusted models, SES was an independent predictor of opioids being prescribed for moderate to severe pain.”
Quote in the paperSubstantial claim - Findingown data
No trend was found between 2006 and 2009 in the frequency of opioid prescriptions for white, black, or other racial groups.
“We did not find a trend between 2006 and 2009 in the frequency of prescriptions written for opioids for white patients (β=0.01;P=0.69), black patients (β=0.03;P=0.32), or patients of other racial groups (β=-0.03;P=0.63).”
Quote in the paperNot a substantial claim
- Findingown data
Black patients were prescribed opioids less frequently than white patients for moderate to severe pain at all levels of socioeconomic status.
“Opioids were prescribed less frequently to black patients for moderate to severe pain compared to white patients at all levels of SES (Fig. 1).”
Quote in the paperSubstantial claim - Findingown data
Adjusting for socioeconomic status did not attenuate the influence of race on opioid prescribing for ED patients with moderate to severe pain.
“Adjusting for SES did not attenuate the influence of race on the prescribing of opioids for patients in the emergency department with moderate to severe pain (Table 2).”
Quote in the paperSubstantial claim - Findingown data
Black patients from lower socioeconomic status neighborhoods were nearly 14% less likely to receive opioids for pain compared to white patients residing in more affluent neighborhoods.
“For instance, black patients from lower SES neighborhoods were approximately 6 % less likely to receive opioids for pain compared to white patients residing in similar neighborhoods, nearly 6 % less likely than black patients in more affluent neighborhoods, and nearly 14 % less likely than white patients residing in more affluent neighborhoods.”
Quote in the paperSubstantial claim - Findingown data
Hispanic patients were prescribed opioids less frequently than non-Hispanic patients for moderate to severe pain (40.4% vs 44.9%; P<0.001).
“Similarly, opioids were prescribed less frequently to Hispanic patients for moderate to severe pain compared to non-Hispanic patients (40.4 % vs. 44.9%; P<0.001).”
Quote in the paperSubstantial claim - Findingown data
Among ED visits for moderate to severe pain, opioid prescribing was more frequent for patients in areas with the highest educational level (>31.69% bachelor's) than for those in the lowest (<12.84%) (46.3% vs 42.5%, P=0.01).
“Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001), household income (47.3 % vs. 40.7 %, P < 0.001), and educational level (46.3 % vs. 42.5 %, P=0.01).”
Quote in the paperSubstantial claim - Findingown data
Similar associations with opioid prescribing were found based on level of income and educational status.
“Similar associations with opioid prescribing were found based on level of income and educational status (Table 2).”
Quote in the paperNot a substantial claim - Findingown data
For moderate to severe pain, white patients presenting to the ED more frequently received opioids compared to black patients (46.4% vs 38.7%; P<0.001).
“For moderate to severe pain, white patients presenting to the ED more frequently received opioids compared to black patients (46.4 % vs. 38.7 %; P< 0.001).”
Quote in the paperSubstantial claim - Findingown data
Regional differences did not attenuate the influence of socioeconomic status or race on opioid prescribing for moderate to severe pain in the ED.
“Despite these regional variations, we did not find that regional differences attenuated the influence of SES or race on the prescribing of opioids for moderate to severe pain in the ED.”
Quote in the paperSubstantial claim - Findingown data
In adjusted models, Hispanic patients were less likely to receive opioids compared to non-Hispanic patients while accounting for percent poverty, median household income, and education level (AORs 0.80-0.83).
“In adjusted models, Hispanic patients were less frequently prescribed opioids compared to non-Hispanic patients while accounting for percent poverty (AOR=0.83,0.75-0.91),median household income (AOR=0.83,0.74-0.88),and education level (AOR=0.80,0.73-0.88)(Table 2).”
Quote in the paperSubstantial claim - Findingown data
Compared to patients in low poverty areas (<5% poverty), those in high poverty areas (>20% poverty) were less likely to receive opioids for moderate to severe pain (39.4% vs 49.0%; AOR 0.76, CI 0.68-0.84).
“Compared to patients in low poverty areas (< 5 % poverty), those residing in high poverty areas (> 20 % poverty) were less likely to receive opioids for moderate to severe pain (39.4 % vs. 49.0 %; AOR 0.76, CI 0.68-0.84).”
Quote in the paperSubstantial claim - Findingown data
Black patients from lower socioeconomic status neighborhoods were nearly 6% less likely to receive opioids for pain compared to black patients in more affluent neighborhoods.
“For instance, black patients from lower SES neighborhoods were approximately 6 % less likely to receive opioids for pain compared to white patients residing in similar neighborhoods, nearly 6 % less likely than black patients in more affluent neighborhoods, and nearly 14 % less likely than white patients residing in more affluent neighborhoods.”
Quote in the paperSubstantial claim - Findingown data
Black patients from lower socioeconomic status neighborhoods were approximately 6% less likely to receive opioids for pain compared to white patients residing in similar neighborhoods.
“For instance, black patients from lower SES neighborhoods were approximately 6 % less likely to receive opioids for pain compared to white patients residing in similar neighborhoods, nearly 6 % less likely than black patients in more affluent neighborhoods, and nearly 14 % less likely than white patients residing in more affluent neighborhoods.”
Quote in the paperSubstantial claim - Findingown data
Among ED visits for moderate to severe pain, opioid prescribing was more frequent for patients in areas with <5% poverty (49.0%) than for those in areas with >20% poverty (39.4%).
“Opioids were prescribed more frequently at visits from patients of the highest SES quartile compared to patients in the lowest quartile, including percent poverty (49.0 % vs. 39.4 %, P<0.001)”
- Also stated in: § Socioeconomic Status · plain
“Compared to patients in low poverty areas (< 5 % poverty), those residing in high poverty areas (> 20 % poverty) were less likely to receive opioids for moderate to severe pain (39.4 % vs. 49.0 %; AOR 0.76, CI 0.68-0.84).”
Quote in the paperSubstantial claim - Also stated in: § Socioeconomic Status · plain
- Findingown data
Disparities based on percent poverty revealed the most striking differences, with an approximate 10% absolute difference in prescribing rates between those in the highest versus lower quartiles.
“Disparities based on the percent of poverty in the patient's neighborhood revealed the most striking differences, with an approximate 10 % absolute difference in prescribing rates between those in the highest versus lower quartiles.”
Quote in the paperSubstantial claim - Interpretationown data
Black and Hispanic patients were less likely to receive opioids for equivalent levels of pain than white/non-Hispanic patients, independent of socioeconomic status.
“Black and Hispanic patients were also less likely to receive opioids for equivalent levels of pain than whites, independent of SES.”
- Also stated in: § CONCLUSION · plain
“Furthermore, black patients and Hispanic patients were less likely to receive opioids for equivalent levels of pain while accounting for socioeconomic status.”
Quote in the paperSubstantial claim - Also stated in: § CONCLUSION · plain
- Study design and conductown data
The sample size did not allow examination of racial differences for Asian or other races.
“Second, our sample size did not allow us to examine racial differences for Asian or other races.”
Quote in the paperNot a substantial claim - Interpretationown data
Patients presenting to US EDs for moderate to severe pain from lower socioeconomic neighborhoods were less likely to receive opioids for equivalent levels of pain compared to those from more affluent neighborhoods.
“Patients presenting to emergency departments from lower SES regions were less likely to receive opioids for equivalent levels of pain than those from more affluent areas.”
- Also stated in: § DISCUSSION · plain
“This study found that patients presenting to emergency departments for moderate to severe pain from lower socioeconomic neighborhoods were less likely to receive an opioid for equivalent levels of pain compared to patients presenting to the ED from more affluent neighborhoods.”
- Also stated in: § CONCLUSION · plain
“Patients presenting to United States emergency departments for moderate to severe pain from lower socioeconomic neighborhoods were less likely to receive opioids for equivalent levels of pain compared to those from more affluent neighborhoods.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Premisecitation
Racial and ethnic disparities in opioid prescribing in the emergency department are well described.
“Racial and ethnic disparities in opioid prescribing in the emergency department (ED) are well described”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2][3][4][5][6][7]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Study design and conductnone given
The study was not able to account for clinician factors, such as race or ethnicity, or institutional level factors.
“Last, we were not able to account for clinician factors, such as race or ethnicity, or institutional level factors.”
Quote in the paperSubstantial claim - Study design and conductnone given
The study was unable to assess whether emergency prescribers employed testing methods such as urine/serum toxicology or prescription monitoring websites.
“We were also unable to assess whether emergency prescribers employed testing methods, such as urine and serum toxicology, or other techniques, such as prescription monitoring websites, to help determine risk for abuse and aid in their decisions on whether or not to prescribe opioids.”
Quote in the paperNot a substantial claim - Interpretationown data
The combination of black race or Hispanic ethnicity and residing in poorer socioeconomic status neighborhoods creates a negative synergistic effect on opioid prescribing for pain.
“The combination of black race or Hispanic ethnicity and residing in poorer SES neighborhoods creates a negative synergistic effect on opioid prescribing for pain.”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 10
- May combine two claims. 6
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe study used NCHS release standards to ensure reliability of national estimates, and all reported values met those criteria.
“The NCHS has established strict release standards for data based on the relative standard error of the point estimate and the absolute number of visits to ensure reliability of national estimates.8 All values reported meet the established release criteria for national estimates.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] National Center for Health Statistics. NCHS public-use data files and documentation: National Hospital Ambulatory Medical Care Survey (NHAMCS)—2006, 2007, 2008, 2009. Available at: ftp://ftp.cdc.gov/pub/health_statistics/nchs/dataset_documentation/nhamcs .
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
Study design and conductown dataModels were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region.
“Models were adjusted for age, sex, pain-level, injury-status, frequency of emergency visits, hospital type, and region.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenCovariates were included based on clinical significance and statistical significance in bivariate analyses.
“All covariates were included based clinical significance and statistical significance in bivariate analyses.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoningThe study included frequency of prior ED visits and recent ED visit to control for frequent visitors.
“To control for whether a patient was a frequent visitor to the ED, we also included the frequency of prior visits to the ED within the past year and whether the patient had been seen in the ED within the past 72 hours.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenData completeness checks were performed by U.S. Bureau of the Census field representatives, and missing data for race and ethnicity were imputed by NCHS.
“Field representatives from the U.S. Bureau of the Census performed checks for data completeness and, when necessary, missing data were imputed by the NCHS for race and ethnicity.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataSocioeconomic status was missing for approximately 5.7% of visits, and visits without socioeconomic status were not included in the analysis.
“Socioeconomic status (either poverty, income, or education) was missing for approximately 5.7 % of visits.Visits without SES were not included in our analysis.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningDisparities in opioid prescribing in EDs exist not only by race and neighborhood-level socioeconomic status, but along regional levels as well.
“Despite these limitations, it is clear that disparities in the prescribing of opioids in emergency departments exist, not only by race and neighborhood-level socioeconomic status, but along regional levels as well.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductown dataStatistical tests were performed using SAS and SUDAAN to weight visits and account for the complex sampling design.
“All Statistical tests were performed using SAS version 9.1 and SAS callable SUDAAN functions to appropriately weight visits and account for the complex sampling design.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenInformation on the quantity and strength of opioids prescribed was not available.
“Third, information on the quantity and strength of opioids prescribed was not available.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoningPain severity was categorized using AHRQ Clinical Practice Guidelines to produce a common measure across years.
“To produce a common measure of pain across the years studied, we used the Clinical Practice Guidelines published by the Agency for Healthcare Research and Quality to categorize pain listed on a 10-point scale to none (0), mild (1-3), moderate (4-6), or severe (7-10).”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductreasoningSeparate models were developed for each measure of socioeconomic status to avoid colinearity.
“To avoid colinearity, we developed separate models for each measure of socioeconomic status (poverty, income, and education).”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationNHAMCS is a national survey designed to collect data on utilization and provision of emergency care throughout the United States, using a multistage probability design and weighted to produce national estimates.
“NHAMCS is a national survey designed to collect data on the utilization and provision of emergency care throughout the United States.8”
- Also stated in: § Data Source · plain
“The survey uses a multistage probability design to select a stratified systematic sample of visits to EDs throughout the United States.The data are then weighted to produce national estimates of utilization of emergency medical care services in the United States.8”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] National Center for Health Statistics. NCHS public-use data files and documentation: National Hospital Ambulatory Medical Care Survey (NHAMCS)—2006, 2007, 2008, 2009. Available at: ftp://ftp.cdc.gov/pub/health_statistics/nchs/dataset_documentation/nhamcs .
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Also stated in: § Data Source · plain
The paper relies on this without support.
The influence of neighborhood socioeconomic status on opioid prescribing for pain in the emergency department is unknown.
“Although racial and ethnic disparities in opioid prescribing in the emergency departments remains steady, the broader influence of socioeconomic status (SES) on the treatment of patients' pain is unknown.”
The paper relies on this without support.
Whether differences in socioeconomic status explain some of the racial and ethnic disparities in opioid prescribing in the emergency setting is unknown.
“Additionally, it is unknown whether differences in SES may explain some of the racial and ethnic disparities previously observed in opioid prescribing in the emergency setting.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Behavioral economics is a conceptual system to understand how one's access and exposure predict demand and subsequent intake.
“The environment in which one resides is a known predictor of consumption behavior (39), thus behavioral economics is a conceptual system to understand how one's access and exposure will predict demand and subsequent intake (40–43).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [41]
Heroin use has significantly increased across most demographic groups.
“Meanwhile, heroin use has significantly increased across most demographic groups (41).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [41]
Individuals with a drug-related death in Norway had lower SES than the general population but overall SES situation prior to death was heterogenous.
“Norwegian data suggests that individuals with a drug-related death had lower SES than the general population but overall SES situation prior to death was heterogenous (41).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [41]
National data suggests higher rates of overdose among the uninsured.
“In a rural part of Wisconsin (92.6% White, median income $46,333), a majority of overdose patients had private insurance (57) which is contrary to national data suggesting higher rates of overdose among the uninsured (41).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [41]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Abstract uses the unadjusted confidence interval for black patients
MinorThe abstract labels 0.73 (0.66-0.81) as an adjusted estimate. Table 2 places that estimate and interval in the unadjusted odds-ratio column; its adjusted poverty-model estimate is 0.73 (0.67-0.80).
“In adjusted models, black patients (AOR 0.73; 95 % CI 0.66-0.81)and patients from poorer areas (AOR 0.76; 95 % CI 0.68-0.86)were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates.”
“| Race White Black Other | 46.4 † 38.7 † 42.2 † | 1.0 0.73 (0.66-0.81) 0.84 (0.72-0.99) | 1.0 0.73 (0.67-0.80) 0.81 (0.68-0.97) | 1.0 0.71 (0.65-0.78) 0.80 (0.66-0.96) | 1.0 0.69 (0.63-0.76) 0.79 (0.66-0.95) |”
Reported opioid-prescribing visits exceed the total unweighted sample
MinorThe Results state that opioids were prescribed in 50,264 visits, but Table 1 gives 50,236 as the total unweighted sample size. The number of opioid-prescribing visits cannot exceed the total number of visits.
“There were 50,264 visits in which opioids were prescribed for moderate or severe pain.Table 1 lists the weighted characteristics of these patient visits.”
“| *Total unweighted sample size was 50,236 patient visits; total | |”
Education categories overlap
MinorThe education ranges 16.67-31.68% and 12.84-19.66% overlap from 16.67% through 19.66%, although they are presented as separate categories.
“| 16.67-31.68 % | 25.9 % |”
“| 12.84-19.66 % | 22.3 % |”
Results assign other-race adjusted odds ratios to black patients
MinorThe three adjusted odds ratios reported for black patients in the Results are the values in Table 2's "Other" race row. The table gives black patients adjusted odds ratios of 0.73, 0.71, and 0.69 for the poverty, income, and education models, respectively.
“In adjusted models, black patients were less frequently prescribed opioids compared to white patients while accounting for percent poverty (AOR=0.81,0.68-0.97),median household income (AOR=0.80,0.66-0.96),and education level (AOR=0.79,0.66-0.95)(Table 2).”
“| Race White Black Other | 46.4 † 38.7 † 42.2 † | 1.0 0.73 (0.66-0.81) 0.84 (0.72-0.99) | 1.0 0.73 (0.67-0.80) 0.81 (0.68-0.97) | 1.0 0.71 (0.65-0.78) 0.80 (0.66-0.96) | 1.0 0.69 (0.63-0.76) 0.79 (0.66-0.95) |”
Abstract's confidence interval for poorer areas differs from the adjusted poverty result
MinorThe abstract reports an adjusted odds ratio of 0.76 with a 0.68-0.86 confidence interval for poorer areas. The Results give the adjusted high-poverty comparison as 0.76 with a 0.68-0.84 interval; 0.76 (0.68-0.86) appears in Table 2 as an unadjusted income comparison.
“In adjusted models, black patients (AOR 0.73; 95 % CI 0.66-0.81)and patients from poorer areas (AOR 0.76; 95 % CI 0.68-0.86)were less likely to receive opioids after accounting for pain-level, age, injury-status, and other covariates.”
“Compared to patients in low poverty areas (< 5 % poverty), those residing in high poverty areas (> 20 % poverty) were less likely to receive opioids for moderate to severe pain (39.4 % vs. 49.0 %; AOR 0.76, CI 0.68-0.84).”
Cites
Joint Commission on Accreditation of Healthcare Organizations
Patterson, C. H. (1995) · Infection Control and Hospital Epidemiology · doi:10.1086/647001 · Cited by 1,338 · see citing works
The Role of Black and Hispanic Physicians in Providing Health Care for Underserved Populations
Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., & Bindman, A. B. (1996) · New England Journal of Medicine · doi:10.1056/nejm199605163342006 · Cited by 915 · see citing works
Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia
Todd, K. H. (1993) · JAMA · doi:10.1001/jama.1993.03500120075029 · Cited by 880 · see citing works
The Gap Gets Bigger: Changes In Mortality And Life Expectancy, By Education, 1981–2000
Meara, E. R., Richards, S., & Cutler, D. M. (2008) · Health Affairs · doi:10.1377/hlthaff.27.2.350 · Cited by 850 · see citing works
Cooper, R., Cutler, J. A., Desvigne-Nickens, P. M., Fortmann, S. P., Friedman, L., Havlik, R. J., Hogelin, G. C., Marler, J. M., McGovern, P. C., Morosco, G. J., et al. (2000) · Circulation · doi:10.1161/01.cir.102.25.3137 · Cited by 830 · see citing works
Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments
Pletcher, M. J., Kertesz, S. G., Kohn, M. A., & Gonzales, R. (2008) · JAMA · doi:10.1001/jama.2007.64 · Cited by 826 · see citing works
Race, Socioeconomic Status, and Breast Cancer Treatment and Survival
Bradley, C. J. (2002) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/94.7.490 · Cited by 657 · see citing works
Manchikanti, L. (2008) · Pain Physician · doi:10.36076/ppj.2008/11/s63 · Cited by 642 · see citing works
JCAHO Pain Management Standards Are Unveiled
Phillips, D. M. (2000) · JAMA · doi:10.1001/jama.284.4.423b · Cited by 565 · see citing works
Cooper, L., & Powe, N. (2004) · doi:10.13016/xfcu-rh1z · Cited by 264 · see citing works
Do Prescription Monitoring Programs Impact State Trends in Opioid Abuse/Misuse?
Reifler, L. M., Droz, D. E., Bailey, J. E., Schnoll, S. H., Fant, R. V., Dart, R. C., & Bartelson, B. B. (2012) · Pain Medicine · doi:10.1111/j.1526-4637.2012.01327.x · Cited by 243 · see citing works
The impact of multiple predictors on generalist physicians' care of underserved populations
Rabinowitz, H. K., Diamond, J. J., Veloski, J. J., & Gayle, J. A. (2000) · American Journal of Public Health · doi:10.2105/ajph.90.8.1225 · Cited by 242 · see citing works
Effects of Socioeconomic Status and Treatment Disparities in Colorectal Cancer Survival
Le, H. V., Ziogas, A., Lipkin, S. M., & Zell, J. A. (2008) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-07-2774 · Cited by 205 · see citing works
Prescribing of Controlled Medications to Adolescents and Young Adults in the United States
Fortuna, R. J., Robbins, B. W., Caiola, E., Joynt, M. R., & Halterman, J. S. (2010) · PEDIATRICS · doi:10.1542/peds.2010-0791 · Cited by 205 · see citing works
Self-citationMadison, T., Schottenfeld, D., James, S. A., Schwartz, A. G., & Gruber, S. B. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.12.2104 · Cited by 189 · see citing works
Green, C. R., Ndao-Brumblay, S. K., West, B. T., & Washington, T. L. (2005) · Journal of Pain · doi:10.1016/j.jpain.2005.06.002 · Cited by 178 · see citing works
JCAHO Pain Management Standards Are Unveiled
Phillips, D. M. (2000) · JAMA · doi:10.1001/jama.284.4.428 · Cited by 164 · see citing works
Racial Disparities in Medical Care
Epstein, A. M., & Ayanian, J. Z. (2001) · New England Journal of Medicine · doi:10.1056/nejm200105103441911 · Cited by 161 · see citing works
Ethnic and Racial Disparities in Emergency Department Care for Mild Traumatic Brain Injury
Bazarian, J. J., Pope, C. A., McClung, J., Cheng, Y. T., & Flesher, W. (2003) · Academic Emergency Medicine · doi:10.1197/s1069-6563(03)00491-3 · Cited by 141 · see citing works
Tamayo-Sarver, J. H., Dawson, N. V., Hinze, S. W., Cydulka, R. K., Wigton, R. S., Albert, J. M., Ibrahim, S. A., & Baker, D. W. (2003) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2003.tb00608.x · Cited by 126 · see citing works
Cultural Competency Training and Performance Reports to Improve Diabetes Care for Black Patients
Sequist, T. D., Fitzmaurice, G. M., Marshall, R., Shaykevich, S., Marston, A., Safran, D. G., & Ayanian, J. Z. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-152-1-201001050-00009 · Cited by 108 · see citing works
Berger, J. T. (2008) · Academic Medicine · doi:10.1097/acm.0b013e31815c6713 · Cited by 75 · see citing works
Dormuth, C. R., Miller, T. A., Huang, A., Mamdani, M., & Juurlink, D. N. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.120465 · Cited by 63 · see citing works
Determinants of variation in analgesic and opioid prescribing practice in an emergency department
Heins, A., Grammas, M., Heins, J. K., Costello, M. W., Kun Huang, M., & Mishra, S. (2006) · Journal of Opioid Management · doi:10.5055/jom.2006.0049 · Cited by 50 · see citing works
Glymour, M. M., Saha, S., & Bigby, J. (2004) · PubMed · Cited by 33 · see citing works
Pollack, C. E., Mallya, G. G., & Polsky, D. E. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0714-x · Cited by 19 · see citing works
RESPONSE Re: Race, Socioeconomic Status, and Breast Cancer Treatment and Survival
Bradley, C. J. (2002) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/94.16.1254-a · Cited by 4
Green, C., Hart-Johnson, T., & Ndao-Brumblay, S. (2006) · The Journal of Pain · doi:10.1016/j.jpain.2006.01.314
Flagged first, then by citations
Research works printed but not linked: 1
- National Center for Health Statistics. NCHS public-use data files and documentation: National Hospital Ambulatory Medical Care Survey (NHAMCS)—2006, 2007, 2008, 2009. Available at: ftp://ftp.cdc.gov/pub/health_statistics/nchs/dataset_documentation/nhamcs .
Cited by
Sorted by citations
CDC Clinical Practice Guideline for Prescribing Opioids for Pain <b>—</b> United States, 2022
Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7103a1 · Cited by 1,886 · see citing works
Optimal pain management for patients with cancer in the modern era
Scarborough, B. M., & Smith, C. B. (2018) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21453 · Cited by 367 · see citing works
Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses
Fink, D. S., Schleimer, J. P., Sarvet, A. L., Grover, K. K., Delcher, C., Castillo‐Carniglia, Á., Kim, J. H., Rivera‐Aguirre, A., Henry, S. G., Martins, S. S., et al. (2018) · Annals of Internal Medicine · doi:10.7326/m17-3074 · Cited by 213 · see citing works
Racial Inequality in Prescription Opioid Receipt — Role of Individual Health Systems
Morden, N. E., Chyn, D., Wood, A., & Meara, E. R. (2021) · New England Journal of Medicine · doi:10.1056/nejmsa2034159 · Cited by 190 · see citing works
Kaplovitch, E., Gomes, T., Camacho, X., Dhalla, I. A., Mamdani, M., & Juurlink, D. N. (2015) · PLoS ONE · doi:10.1371/journal.pone.0134550 · Cited by 153 · see citing works
Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction
Marcusa, D. P., Mann, R. A., Cron, D. C., Fillinger, B., Rzepecki, A. K., Kozlow, J. H., Momoh, A. O., Englesbe, M. J., Brummett, C. M., & Waljee, J. F. (2017) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000003832 · Cited by 104 · see citing works
The Influence of Community and Individual Health Literacy on Self-Reported Health Status
Sentell, T. L., Zhang, W., Davis, J. W., Baker, K. K., & Braun, K. L. (2013) · Journal of General Internal Medicine · doi:10.1007/s11606-013-2638-3 · Cited by 103 · see citing works
Sex and Race Differences in Pain Sensitization among Patients with Chronic Low Back Pain
Meints, S. M., Wang, V. C., & Edwards, R. R. (2018) · Journal of Pain · doi:10.1016/j.jpain.2018.07.001 · Cited by 98 · see citing works
Williams, E. C., Gupta, S., Rubinsky, A. D., Glass, J. E., Jones‐Webb, R., Bensley, K. M., & Harris, A. H. S. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.06.011 · Cited by 75 · see citing works
Hirsh, A. T., Miller, M. M., Hollingshead, N. A., Anastas, T., Carnell, S., Lok, B. C. L., Chu, C., Zhang, Y., Robinson, M. E., Kroenke, K., et al. (2019) · Pain · doi:10.1097/j.pain.0000000000001634 · Cited by 73 · see citing works
Atkins, N., & Mukhida, K. (2022) · Canadian journal of pain = Revue canadienne de la douleur · doi:10.1080/24740527.2022.2104699 · Cited by 62 · see citing works
Ilowite, M. F., Al‐Sayegh, H., Ma, C., Dussel, V., Rosenberg, A. R., Feudtner, C., Kang, T. I., Wolfe, J., & Bona, K. O. (2018) · Cancer · doi:10.1002/cncr.31668 · Cited by 67 · see citing works
“Under the Skin” and into the Gut: Social Epidemiology of the Microbiome
Dowd, J. B., & Renson, A. (2018) · Current Epidemiology Reports · doi:10.1007/s40471-018-0167-7 · Cited by 65 · see citing works
Knoebel, R. W., Starck, J. V., & Miller, P. (2021) · Health Equity · doi:10.1089/heq.2020.0062 · Cited by 60 · see citing works
Chronic Noncancer Pain Management and Systemic Racism: Time to Move Toward Equal Care Standards
Ghoshal, M., Shapiro, H., Todd, K., & Schatman, M. (2020) · Journal of Pain Research · doi:10.2147/jpr.s287314 · Cited by 47 · see citing works
Anastas, T. M., Miller, M. M., Hollingshead, N. A., Stewart, J. C., Rand, K. L., & Hirsh, A. T. (2020) · Annals of Behavioral Medicine · doi:10.1093/abm/kaaa016 · Cited by 56 · see citing works
Neighborhood socioeconomic status and receipt of opioid medication for new back pain diagnosis
Gebauer, S., Salas, J., & Scherrer, J. F. (2017) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2017.06.170061 · Cited by 53 · see citing works
Quantitative sensory testing and pain-evoked cytokine reactivity
Campbell, C. M., Carroll, C. P., Kiley, K. B., Han, D., Haywood, C., Lanzkron, S., Swedberg, L., Edwards, R. R., Page, G. G., & Haythornthwaite, J. A. (2015) · Pain · doi:10.1097/j.pain.0000000000000473 · Cited by 54 · see citing works
Poverty and pain: Low-SES people are believed to be insensitive to pain
Summers, K. M., Deska, J. C., Almaraz, S. M., Hugenberg, K., & Lloyd, E. P. (2021) · Journal of Experimental Social Psychology · doi:10.1016/j.jesp.2021.104116 · Cited by 62 · see citing works
The Delaware Pain Database: a set of painful expressions and corresponding norming data
Mende‐Siedlecki, P., Qu-Lee, J. W., Lin, J., Drain, A., & Goharzad, A. (2020) · PAIN Reports · doi:10.1097/pr9.0000000000000853 · Cited by 51 · see citing works
Race and Gender Are Associated with Opioid Dose Reduction Among Patients on Chronic Opioid Therapy
Buonora, M. J., Perez, H. R., Heo, M., Cunningham, C. O., & Starrels, J. L. (2018) · Pain Medicine · doi:10.1093/pm/pny137 · Cited by 51 · see citing works
Chen, T., Chen, L., Kerry, M., & Knaggs, R. (2019) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2018.10.013 · Cited by 51 · see citing works
Mixed studies review of factors influencing receipt of pain treatment by injured black patients
Aronowitz, S. V., McDonald, C. C., Stevens, R. C., & Richmond, T. S. (2019) · Journal of Advanced Nursing · doi:10.1111/jan.14215 · Cited by 50 · see citing works
Kilaru, A. S., Gadsden, S. M., Perrone, J., Paciotti, B., Barg, F. K., & Meisel, Z. F. (2014) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2014.03.015 · Cited by 50 · see citing works
Opioid Use Disorder and Racial/Ethnic Health Disparities: Prevention and Management
Siddiqui, N., & Urman, R. D. (2022) · Current Pain and Headache Reports · doi:10.1007/s11916-022-01010-4 · Cited by 45 · see citing works
Patient race, ethnicity, and care in the emergency department: A scoping review
Owens, A., Holroyd, B. R., & McLane, P. (2020) · Canadian Journal of Emergency Medicine · doi:10.1017/cem.2019.458 · Cited by 44 · see citing works
A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health
Wiss, D. A. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00193 · Cited by 41 · see citing works
Forati, A. M., Ghose, R., & Mantsch, J. R. (2021) · Journal of Urban Health · doi:10.1007/s11524-021-00554-x · Cited by 40 · see citing works
The Intersections of Chronic Noncancer Pain: Culturally Diverse Perspectives on Disease Burden
Brady, B., Veljanova, I., & Chipchase, L. S. (2018) · Pain Medicine · doi:10.1093/pm/pny088 · Cited by 38 · see citing works
Substance Use Stigma, Primary Care, and the New York State Prescription Drug Monitoring Program
Allen, B., Harocopos, A., & Chernick, R. (2019) · Behavioral Medicine · doi:10.1080/08964289.2018.1555129 · Cited by 38 · see citing works
Vitzthum, L. K., Nalawade, V. V., Riviere, P. J., Sumner, W., Nelson, T. J., Mell, L. K., Furnish, T. J., Rose, B. S., Martı́nez, M. E., & Murphy, J. D. (2021) · JCO Oncology Practice · doi:10.1200/op.20.00773 · Cited by 39 · see citing works
Framework for opioid stigma in cancer pain
Bulls, H. W., Chu, E., Goodin, B. R., Liebschutz, J. M., Wozniak, A. J., Schenker, Y., & Merlin, J. S. (2021) · Pain · doi:10.1097/j.pain.0000000000002343 · Cited by 41 · see citing works
Chisholm‐Burns, M. A., Spivey, C. A., Gatwood, J. D., Wiss, A. L., Hohmeier, K. C., & Erickson, S. R. (2017) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp150872 · Cited by 38 · see citing works
Paganini, G. A., Summers, K. M., ten Brinke, L., & Lloyd, E. P. (2023) · Journal of Experimental Social Psychology · doi:10.1016/j.jesp.2023.104520 · Cited by 37 · see citing works
Does a Primary Health Clinic for Formerly Incarcerated Women Increase Linkage to Care?
Morse, D. S., Wilson, J. L., McMahon, J. M., Dozier, A. M., Quiroz, A., & Cerulli, C. (2017) · Women s Health Issues · doi:10.1016/j.whi.2017.02.003 · Cited by 36 · see citing works
Darby, A., Manchanda, E. C. C., Janeway, H. H., Samra, S. S., Hicks, M., Long, R., Gipson, K. A., Chary, A. N., Adjei, B. A., Khanna, K., et al. (2022) · Academic Emergency Medicine · doi:10.1111/acem.14601 · Cited by 34 · see citing works
Use and Opinions of Prescription Opioids Among Older American Adults: Sociodemographic Predictors
Grol-Prokopczyk, H. (2018) · The Journals of Gerontology Series B · doi:10.1093/geronb/gby093 · Cited by 34 · see citing works
Managing acute pain in children presenting to the emergency department without opioids
Chumpitazi, C. E., Chang, C. D., Atanelov, Z., Dietrich, A. M., Lam, S. H. F., Rose, E., Ruttan, T., Shahid, S., Stoner, M. J., Sulton, C., et al. (2022) · Journal of the American College of Emergency Physicians Open · doi:10.1002/emp2.12664 · Cited by 35 · see citing works
Placebo hypoalgesia: racial differences
Okusogu, C., Wang, Y., Akintola, T., Haycock, N. R., Raghuraman, N., Greenspan, J. D., Phillips, J. L., Dorsey, S. G., Campbell, C. M., & Colloca, L. (2020) · Pain · doi:10.1097/j.pain.0000000000001876 · Cited by 33 · see citing works
Does Intra-household Contagion Cause an Increase in Prescription Opioid Use?
de Vaan, M., & Stuart, T. E. (2019) · American Sociological Review · doi:10.1177/0003122419857797 · Cited by 30 · see citing works
Brown, J. H., Torres, H. P., Maddi, R. D., Williams, J. L., Dibaj, S. S., Liu, D., & Bruera, E. D. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.06.015 · Cited by 32 · see citing works
Savoia, G., Coluzzi, F., Maria, C. D., Ambrósio, F., Corte, F. D., Oggioni, R., Messina, A., Costantini, A., Launo, C., Mattia, C., et al. (2015) · PubMed · Cited by 32 · see citing works
Bulls, H. W., Hamm, M., Wasilko, R., Cameron, F. D. A., Belin, S. C., Goodin, B. R., Liebschutz, J. M., Wozniak, A. J., Sabik, L. M., Merlin, J. S., et al. (2022) · JCO Oncology Practice · doi:10.1200/op.22.00251 · Cited by 30 · see citing works
Opioid Prescribing and Outcomes in Patients With Sickle Cell Disease Post–2016 CDC Guideline
Kang, H. A., Wang, B., Barner, J. C., Ataga, K. I., Mignacca, R. C., Chang, A. K., & Zhang, Y. (2024) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2023.8538 · Cited by 29 · see citing works
Pain behind bars: the epidemiology of pain in older jail inmates in a county jail
Williams, B. A., Ahalt, C., Stijacic-Cenzer, I., Smith, A. K., Goldenson, J., & Ritchie, C. S. (2014) · Journal of Palliative Medicine · doi:10.1089/jpm.2014.0160 · Cited by 27 · see citing works
Medicine ‘misuse’: Implications for health and environmental sustainability
Thomas, F., & Depledge, M. H. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.08.028 · Cited by 27 · see citing works
Carlsson, A. C., Wändell, P. E., Gašević, D., Sundquist, J., & Sundquist, K. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2015.04.005 · Cited by 27 · see citing works
Singh, S. A., Moreland, R., Fang, W., Shaikh, P. M., Perez, J. M., Morris, A. M., Dahshan, B. A., Krc, R. F., Chandran, D. N., & Holbein, M. (2021) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2021.05.002 · Cited by 26 · see citing works
Racial disparities in opioid administration and prescribing in the emergency department for pain
Kang, H., Zhang, P., Lee, S., Shen, S., & Dunham, E. (2022) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2022.02.043 · Cited by 26 · see citing works
A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents
Dash, G. F., Wilson, A. C., Morasco, B. J., & Ewing, S. W. F. (2018) · Clinical Psychological Science · doi:10.1177/2167702618773323 · Cited by 26 · see citing works
Opioid Prescriptions After Hemorrhoidectomy
Lu, P. W., Fields, A. C., Andriotti, T., Welten, V. M., Rojas-Alexandre, M., Koehlmoos, T. P., Schoenfeld, A. J., & Melnitchouk, N. (2020) · Diseases of the Colon & Rectum · doi:10.1097/dcr.0000000000001570 · Cited by 25 · see citing works
Geospatial Variations and Neighborhood Deprivation in Drug-Related Admissions and Overdoses
Cobert, J. M., Lantos, P. M., Janko, M., Williams, D. G. A., Raghunathan, K., Krishnamoorthy, V. K., JohnBull, E. A., Barbeito, A., & Gulur, P. (2020) · Journal of Urban Health · doi:10.1007/s11524-020-00436-8 · Cited by 23 · see citing works
Do Prescription Drug Monitoring Programs Encourage Prescription – or Illicit – Opioid Abuse?
Meadowcroft, D., & Whitacre, B. E. (2019) · Substance Abuse · doi:10.1080/08897077.2019.1695707 · Cited by 22 · see citing works
Watanabe, J. H., Kazerooni, R., & Bounthavong, M. (2014) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2014.20.1.43 · Cited by 21 · see citing works
Pain sensitivity differs between dog breeds but not in the way veterinarians believe
Caddiell, R., Cunningham, R., White, P., Lascelles, B. X., & Gruen, M. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1165340 · Cited by 20 · see citing works
Parent responses to pediatric pain: The differential effects of ethnicity on opioid consumption
Donaldson, C. D., Jenkins, B. N., Fortier, M. A., Phan, M., Tomaszewski, D. M., Yang, S., & Kain, Z. N. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110251 · Cited by 19 · see citing works
Harris, A. B., Zhang, B., Marrache, M., Puvanesarajah, V., Raad, M., Hassanzadeh, H. R., Bicket, M. C., & Jain, A. (2020) · Neurospine · doi:10.14245/ns.2040122.061 · Cited by 18 · see citing works
Bernardes, S. F., Tomé-Pires, C., Brandão, T., Campos, L., Teixeira, F., & Goubert, L. (2021) · Pain · doi:10.1097/j.pain.0000000000002278 · Cited by 18 · see citing works
Asfaw, A., Alterman, T., & Quay, B. (2019) · International Journal of Health Services · doi:10.1177/0020731419881336 · Cited by 18 · see citing works
Chuang, E. J., Gil, E. N., Gao, Q., Kligler, B., & McKee, M. D. (2018) · Pain Medicine · doi:10.1093/pm/pny169 · Cited by 16 · see citing works
Language barriers and postoperative opioid prescription use after total knee arthroplasty
Nguyen, K., Rambachan, A., Ward, D., & Manuel, S. P. (2022) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2022.100171 · Cited by 16 · see citing works
Racial/Ethnic Disparities in Pain Burden and Pain Management in the Context of Opioid Overdose Risk
Samuel, C. A., Corbie-Smith, G. M., & Cykert, S. (2019) · Current Epidemiology Reports · doi:10.1007/s40471-019-00202-8 · Cited by 16 · see citing works
How opioids became “safe”: pharmaceutical splitting and the racial politics of opioid safety
Parker, C. M., & Hansen, H. (2021) · BioSocieties · doi:10.1057/s41292-021-00230-y · Cited by 15 · see citing works
Ezell, J. M., Pho, M. T., Ajayi, B. P., Simek, E., Shetty, N., Goddard‐Eckrich, D., & Bluthenthal, R. N. (2024) · Drug and Alcohol Review · doi:10.1111/dar.13832 · Cited by 14 · see citing works
Bulls, H. W., Hamm, M., Wasilko, R., Cameron, F. D. A., Belin, S. C., Goodin, B. R., Liebschutz, J. M., Wozniak, A. J., Sabik, L. M., Schenker, Y., et al. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.01.015 · Cited by 13 · see citing works
Attrill, S., Lincoln, M., & McAllister, S. (2017) · International Journal of Speech-Language Pathology · doi:10.1080/17549507.2017.1292548 · Cited by 14 · see citing works
Opioid Prescribing Patterns After Anorectal Surgery
Leinicke, J. A., Carbajal, V., Senders, Z. J., Patil, N. T., Wogsland, A. A., Stein, S. L., & Steinhagen, E. F. (2020) · Journal of Surgical Research · doi:10.1016/j.jss.2020.05.098 · Cited by 14 · see citing works
Islam, M. M., & Wollersheim, D. (2018) · Pharmaceuticals · doi:10.3390/ph11040116 · Cited by 12 · see citing works
Connelly, M. A., Glynn, E. F., Hoffman, M. A., & Bickel, J. L. (2019) · Pediatric emergency care · doi:10.1097/pec.0000000000001851 · Cited by 12 · see citing works
Hispanics, Addictions, and the Opioid Epidemic: Brief Report
Brenes, F., & Henriquez, F. (2019) · Hispanic Health Care International · doi:10.1177/1540415319888437 · Cited by 12 · see citing works
Dhinsa, J., Roman-Urrestarazu, A., van Kessel, R., & Humphreys, K. (2023) · Global Epidemiology · doi:10.1016/j.gloepi.2023.100109 · Cited by 13 · see citing works
Thompson, T., Stathi, S., Buckley, F., Shin, J. I., & Liang, C. (2023) · Journal of General Internal Medicine · doi:10.1007/s11606-023-08401-2 · Cited by 11 · see citing works
Poor Toddlers Feel Less Pain? Application of Class-Based Pain Stereotypes in Judgments of Children
Summers, K. M., Paganini, G. A., & Lloyd, E. P. (2022) · Social Psychological and Personality Science · doi:10.1177/19485506221094087 · Cited by 12 · see citing works
On race, human variation, and who gets and dies of sepsis
Brinkworth, J. F., & Shaw, J. G. (2022) · American Journal of Biological Anthropology · doi:10.1002/ajpa.24527 · Cited by 9 · see citing works
Higgins, C., Smith, B. H., & Colvin, L. (2020) · Pain · doi:10.1097/j.pain.0000000000002098 · Cited by 9 · see citing works
Opioid use and social disadvantage in patients with chronic musculoskeletal pain
Cheng, A. L., Brady, B. K., Bradley, E. C., Calfee, R. P., Klesges, L. M., Colditz, G. A., & Prather, H. (2021) · PM&R · doi:10.1002/pmrj.12596 · Cited by 12 · see citing works
‘First Do No Harm’: physician discretion, racial disparities and opioid treatment agreements
Beck, A., Svirsky, L., & Howard, D. (2021) · Journal of Medical Ethics · doi:10.1136/medethics-2020-107030 · Cited by 10 · see citing works
Pain in patients attended at risk classification of an emergency service
da Silva, J. S., da Cruz, T. A. F., Ribeiro, C. J. N., Santos, V. S., Alves, J. A. B., & Ribeiro, M. D. C. D. O. (2016) · Revista Dor · doi:10.5935/1806-0013.20160009 · Cited by 9 · see citing works
Identities as predictors of vaccine hesitancy during the COVID‐19 pandemic
Heiman, S. L., Hirt, E. R., Isch, C. G., Brinkworth, J. F., Cronk, L., Alcock, J., Aktipis, A., & Todd, P. M. (2022) · Journal of Social Issues · doi:10.1111/josi.12569 · Cited by 8 · see citing works
Hollingshead, N. A., Matthias, M. S., Bair, M. J., & Hirsh, A. T. (2016) · Digital Scholarship - UNLV (University of Nevada Reno) · Cited by 8 · see citing works
O’Sullivan, L. R., Shofer, F. S., Delgado, M. K., et al. (2023) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000002596 · Cited by 7 · see citing works
Examining disparities in regional anaesthesia and pain medicine
Umeh, U. O. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.02.015 · Cited by 8 · see citing works
Neighborhood disadvantage and prescription drug misuse in low-income urban mothers.
Bernhardt, C., & King, C. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.109245 · Cited by 6 · see citing works
Boley, S. P., Sidebottom, A. C., Stenzel, A. E., & WATSON, D. A. (2023) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-023-01529-1 · Cited by 7 · see citing works
Fereydooni, S., Lorenz, K., Azarfar, A., Luckett, T., Phillips, J. L., Becker, W. C., & Giannitrapani, K. F. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-082033 · Cited by 8 · see citing works
Risk Factors for Opioid Overdose
Lipato, T., & Terplan, M. (2018) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-018-0153-1 · Cited by 7 · see citing works
Adolescent opioid use: Examining the intersection of multiple inequalities
Bares, C. B., Weaver, A., & Kelso, M. (2019) · Journal of Prevention & Intervention in the Community · doi:10.1080/10852352.2019.1617382 · Cited by 7 · see citing works
Anastas, T., Wu, W., Burgess, D. J., Stewart, J. C., Salyers, M. P., Kroenke, K., & Hirsh, A. T. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.01.345 · Cited by 7 · see citing works
An Initial Psychometric Evaluation of the Pain Concepts Questionnaire in a Low-SES Setting
Newman, A. K., Moraís, C. A., Dyke, B. P. V., & Thorn, B. E. (2020) · Journal of Pain · doi:10.1016/j.jpain.2020.05.002 · Cited by 7 · see citing works
Opioids or Steroids for Pneumonia or Sinusitis
Phang, K. G., Roberts, J. R., Ebeling, M. D., et al. (2020) · PEDIATRICS · doi:10.1542/peds.2019-3690 · Cited by 6 · see citing works
Do Socioeconomic Disparities Exist in Postoperative Opioid Prescription and Consumption?
Srinivasan, M., Zaveri, S. R., Nobel, T. B., Khetan, P., & Divino, C. M. (2020) · The American Surgeon · doi:10.1177/0003134820942283 · Cited by 6 · see citing works
Home Health Agencies With More Socially Vulnerable Patients Have Poorer Experience of Care Ratings
Wang, J., Ying, M., & Li, Y. (2021) · Journal of Applied Gerontology · doi:10.1177/07334648211053859 · Cited by 6 · see citing works
Pain Management for Older African Americans in the Perianesthesia Setting: The “Eight I's”
Booker, S. Q., & Herr, K. (2015) · Journal of PeriAnesthesia Nursing · doi:10.1016/j.jopan.2015.01.011 · Cited by 6 · see citing works
Antwi‐Amoabeng, D., Beutler, B. D., Ghuman, J., et al. (2024) · Cureus · doi:10.7759/cureus.56845 · Cited by 5 · see citing works
Davies, E. C., Sewell, B., Jones, M., Phillips, C. J., & Rance, J. Y. (2020) · BJGP Open · doi:10.3399/bjgpopen20x101122 · Cited by 5 · see citing works
Ehntholt, A., Pabayo, R., Berkman, L. F., & Kawachi, I. I. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312289 · Cited by 6 · see citing works
Lavanga, E. A., Samaan, F., DeHaven, C., Ramirez, M. C. C., & Aziz, F. (2024) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2024.08.009 · Cited by 4 · see citing works
Veterinary education and experience shape beliefs about dog breeds Part 1: Pain sensitivity
Caddiell, R. M. P., White, P. A., Lascelles, B. D. X., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-40671-y · Cited by 4 · see citing works
Morris, M. C., Moradi, H., Aslani, M., Sun, S., Karlson, C., Bartley, E. J., Bruehl, S. P., Archer, K. R., Bergin, P. F., Kinney, K. L., et al. (2024) · Pain · doi:10.1097/j.pain.0000000000003451 · Cited by 5 · see citing works
Zerillo, J., Agarwal, P., Poeran, J., et al. (2018) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000003579 · Cited by 4 · see citing works
- Authors
- Joynt, M., Train, M. K., Robbins, B. W., Halterman, J. S., Caiola, E., & Fortuna, R. J.
- Affiliations
- University of Rochester Medicine (US)
- Corresponding author
- Fortuna, Robert J.
- Venue
- Journal of General Internal Medicine
- Published
- 2013-06-25
- Volume
- 28
- Issue
- 12
- Pages
- 1604-1610
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC3832731
- OpenAlex
- W2147530350
- Semantic Scholar
- f1c6bf89669f7fc82a96b622e64387231b365a70
- Cited by
- 152
- References
- 28
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 15 · 2023: 16 · 2022: 15 · 2021: 16 · 2020: 21 · 2019: 18 · 2018: 13 · 2017: 8 · 2016: 3 · 2015: 7 · 2014: 3 · 2013: 3
- FWCI
- 5.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- opioid prescribing, neighborhood socioeconomic status, racial disparities, emergency department visits, moderate to severe pain, Black patients, Hispanic patients, poverty, household income, educational attainment, pain management
- MeSH terms
- Adolescent, Adult, Aged, Analgesics, Opioid, Cross-Sectional Studies, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Pain, Practice Patterns, Physicians', Poverty, Residence Characteristics, Social Class, United States, Racial Groups, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-14.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-14.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
