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291: Racial disparities in postpartum pain management

      Objective

      Multiple studies have demonstrated racial/ethnic minority individuals receive less treatment for similar levels of pain than non-Hispanic white (NHW) individuals. Whether this association exists in the postpartum setting remains unknown. We sought to evaluate racial/ethnic differences in women’s postpartum pain scores, inpatient opioid administration, and discharge opioid prescribing.

      Study Design

      Retrospective cohort study of all deliveries at a single, high-volume tertiary care center (12/2015-16). Women were included if they self-identified as NHW, non-Hispanic black (NHB), or Hispanic. Medical records were queried for three outcomes: 1) patient-reported postpartum pain score at discharge (dichotomized <5 or ≥5); 2) inpatient opioid dosing during postpartum hospitalization (reported as morphine milligram equivalents [MME] per postpartum day); and 3) receipt of an opioid prescription at discharge. The associations between each of these outcomes and maternal race/ethnicity were assessed using multivariable logistic regression models with random effects to account for clustering by discharge physician.

      Results

      Of 9,900 women eligible for analysis, 68.4% identified as NHW, 21.0% as Hispanic, and 10.6% as NHB. On bivariable analyses, Hispanic and NHB women were more likely to report postpartum pain scores ≥5 (p<0.001), but received less inpatient MME/day (p<0.001) and were less likely to receive an opioid prescription at discharge than NHW women (p<0.001) (Figure). On multivariable analyses, these findings remained statistically significant (Table). Specifically, compared to NHW women, Hispanic women had significantly greater odds of reporting a pain score of ≥ 5 (aOR 1.69; 95% 1.33-2.15), but received significantly less inpatient MME/day (aβ -4.77; 95% CI -6.59 to -0.62) and were significantly less likely to receive an opioid prescription at discharge (aOR 0.81; 95% CI 0.68-0.97). Similarly, NHB women had significantly greater odds of reporting a pain score ≥5 (aOR 2.66; 95% 2.05-3.45), but received significantly less inpatient MME/day (aβ -2.79; 95% CI -4.95 to -0.62) and were significantly less likely to receive an opioid prescription at discharge (aOR 0.81; 95% CI 0.65-0.99).

      Conclusion

      Hispanic and NHB women experience disparities in pain management in the postpartum setting that cannot be explained by less perceived pain.
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