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Area of Science:

  • Health Services Research
  • Pain Management
  • Health Disparities

Background:

  • African Americans (AAs) face significant disparities in chronic pain management.
  • Emergency department (ED) utilization for chronic pain is a critical indicator of care access and quality.

Purpose of the Study:

  • To compare ED utilization rates for chronic pain diagnoses between African American (AA) and White Veterans.
  • To identify factors contributing to observed racial differences in ED use for chronic pain.

Main Methods:

  • Retrospective analysis of national Veterans Affairs administrative data from 2018.
  • Inclusion of Veterans with chronic pain diagnoses, comparing AA and White populations.
  • Negative binomial regression models used to assess ED utilization, controlling for covariates.

Main Results:

  • AA Veterans had a 58% higher incidence rate ratio of ED utilization for chronic pain compared to White Veterans (IRR: 1.58).
  • Rurality was the only factor significantly reducing the race effect on ED use.
  • After multivariable adjustment, the disparity remained substantial, with AA Veterans showing a 37% higher risk of ED utilization (IRR: 1.37).

Conclusions:

  • Significant disparities exist in ED utilization for chronic pain care among AA Veterans compared to White Veterans.
  • These findings suggest potential inequities in outpatient chronic pain management for AA Veterans.
  • Improving therapeutic alliance in primary care may be crucial for enhancing chronic pain treatment for AA Veterans.