Exploring Demographic Differences in Postintubation Analgesia by Racial Group, Sex, and Age

After rapid sequence intubation (post-RSI), patients require analgesia to ensure adequate pain management; however, extant research suggests that in other medical procedures, there are demographic differences in analgesic prescribing.

We examined potential sociodemographic differences in post-RSI opioid prescribing across a Med-Atlantic healthcare system. We hypothesized that Black (vs. White), female (vs. male), and older (vs. younger) patients would receive lower opioid doses post-RSI.

We conducted a retrospective chart review of all intubated adults (analytic n = 1211; 65.81% Black; 46.05% Female; Age Median = 61.00 [60.00, 63.00]) in 2019. We extracted demographics (sex, racial group, age), comorbidities, and opioid dose in Milligram Morphine Equivalent (MME). As only 29.4% of patients received an opioid, we tested our hypotheses with a zero-inflated Poisson model.

Increasing age was associated with a significantly lower likelihood of receiving an opioid (odds ratios [OR] = 0.81, p = 0.021) and lower MME doses when they received an opioid (rate ratio [RR] = 0.87, p < 0.001). Black (vs. White) patients had significantly higher odds of receiving an opioid (OR = 1.66, p = 0.010), but lower MME doses (RR = 0.71, p < 0.001). Sex did not significantly influence opioid prescribing likelihood, but if they received an opioid, female patients received lower MME than male patients (RR = 0.90, p = 0.018).

Our data revealed significant racialized, sex-, and age-based disparities and inequities in opioid prescribing postintubation. Future work is needed to examine best practices in age-related post-RSI opioid recommendations and establish standardized practices that promote equitable analgesia for all patients.