Black, Asian Patients Receive Lower Doses of Opioids for Hip Fractures, Study Finds

Older adults recovering from hip fractures face challenges in managing pain as they transition from hospital care to community settings. A new study in the Journal of the American Geriatrics Society uncovered disparities in opioid prescribing by race among Medicare beneficiaries, sparking concerns about potential impacts on rehabilitation outcomes.

The findings reveal racial disparities in opioid prescribing for pain management among older adults after hip fractures, with Black and Asian patients receiving significantly lower doses than White patients.

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Researchers conducted a retrospective cohort study of 164,170 Medicare beneficiaries aged 65 and older who were hospitalized for hip fractures. The study aimed to determine whether there were racial differences in the receipt and dosage of opioids as these patients transitioned back to the community. The outcomes measured were the receipt of an opioid prescription and the total opioid doses in the first 90 days after discharge, expressed in milligram morphine equivalents (MMEs) and milligrams of oxycodone.

The analysis showed that while a similar proportion of Black and White beneficiaries used opioids after returning home from the hospital, Black patients consistently received lower doses of these medications. On average, Black beneficiaries received approximately 250 milligrams less oxycodone over 90 days compared with their White counterparts, equating to around 5.8 milligrams fewer oxycodone per day.

Furthermore, Asian beneficiaries experienced even greater reductions in opioid doses. They were prescribed between 617 to 653 milligrams less oxycodone in total over the 90-day period than White patients.

The study also stratified patients based on whether they received institutional post-acute care (PAC). The findings revealed that, regardless of PAC status, Black beneficiaries received lower cumulative opioid doses.

• PAC Group: Black patients received 165 fewer MMEs (equivalent to 248 mg of oxycodone).
• No PAC Group: Black patients received 167 fewer MMEs (equivalent to 251 mg of oxycodone).

When examining the average daily dose:

• PAC Group: Black beneficiaries received 3.0 fewer MMEs daily (equivalent to 4.5 mg of oxycodone).
• No PAC Group: Black beneficiaries received 4.7 fewer MMEs daily (equivalent to 7.1 mg of oxycodone).

The researchers emphasized the need for equitable pain management strategies, as inadequate pain control can hinder rehabilitation and increase the risk of future injury.

“These differences could represent racial disparities in how we treat pain after hip fractures, which could result in poorer long-term outcomes and repeat fractures,” study author Kaleen N. Hayes, PharmD, PhD, of Brown University School of Public Health, said in a statement.

Future research should explore the reasons behind these disparities and evaluate their impact on short- and long-term health outcomes, the study noted. Ensuring equitable pain management is essential for improving recovery and preventing complications in vulnerable populations.

Reference

Hayes KN, Cupp MA, Joshi R, Riester MR, Beaudoin FL, Zullo AR. Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care. J Am Geriatr Soc. 2024; 1-12. doi:10.1111/jgs.19160