Racial Inequality in Prescription Opioid Receipt - Role of Individual Health Systems.
Racial Inequality in Prescription Opioid Receipt - Role of Individual Health Systems.
复制标题
DOI：
10.1056/nejmsa2034159
复制
发表时间：
2021-07-22
期刊：
影响因子：
--
通讯作者：
Meara E
中科院分区：
文献类型：
--
作者：
Morden NE;Chyn D;Wood A;Meara E
从历史上看，处方阿片类药物的接收在美国的种族群体中有所不同。研究还没有通过检查系统内处方阿片类药物收据来充分探讨个人卫生系统对这些差异的贡献。我们使用了2016年和2017年的医疗保险索赔数据，这些数据来自一个随机的40%的全国样本，这些样本是按服务收费的，18至64岁的黑人和白人受益人，他们属于卫生系统。我们确定了310个种族多样化系统（定义为黑人和白人患者各≥200人年的系统）。为了测试代表性，我们比较了这310个系统中患者的特征和阿片类药物接受情况与国家样本中的患者。在310个系统中，回归模型用于探索黑人和白人患者在以下年度阿片类药物测量方面的差异：任何处方的填写，阿片类药物的短期接收，阿片类药物的长期接收（一年中所有四个日历季度的一个或多个阿片类药物处方），以及吗啡毫克当量（MME）的阿片类药物剂量；模型控制病人的特征，状态和系统。全国样本包括2,197,153人年，310个种族多样化系统的样本包括896,807人年（占全国样本中所有患者的47.4%和黑人患者的56.1%）。全国样本和310系统样本仅在黑人患者贡献的人年百分比上有意义的差异（21.3%对25.9%）。在310个系统的样本中，任何阿片类药物收据的粗年患病率在黑人和白人患者之间略有差异（50.2%对52.2%），而黑人患者的平均年剂量比白人患者低36% （5190 MME对8082 MME）。在系统内，调整后的种族差异与人口趋势相似：阿片类药物接受的年流行率差异不大，但91%的系统中白人患者的平均年剂量高于黑人患者，75%的系统中至少高出15%。在个人卫生系统中，黑人和白人患者接受的阿片类药物剂量明显不同。这些系统特有的发现有助于探索这些差异的原因和后果。（由国家老龄化研究所和医疗保健研究与质量局资助。）
Historically, the receipt of prescription opioids has differed among racial groups in the United States. Research has not sufficiently explored the contribution of individual health systems to these differences by examining within-system prescription opioid receipt according to race. We used 2016 and 2017 Medicare claims data from a random 40% national sample of fee-for-service, Black and White beneficiaries 18 to 64 years of age who were attributed to health systems. We identified 310 racially diverse systems (defined as systems with ≥200 person-years each for Black and White patients). To test representativeness, we compared patient characteristics and opioid receipt among the patients in these 310 systems with those in the national sample. Within the 310 systems, regression models were used to explore the difference between Black and White patients in the following annual opioid measures: any prescription filled, short-term receipt of opioids, long-term receipt of opioids (one or more filled opioid prescriptions in all four calendar quarters of a year), and the opioid dose in morphine milligram equivalents (MME); models controlled for patient characteristics, state, and system. The national sample included 2,197,153 person-years, and the sample served by 310 racially diverse systems included 896,807 person-years (representing 47.4% of all patients and 56.1% of Black patients in the national sample). The national sample and 310-systems sample differed meaningfully only in the percent of person-years contributed by Black patients (21.3% vs. 25.9%). In the 310-systems sample, the crude annual prevalence of any opioid receipt differed slightly between Black and White patients (50.2% vs. 52.2%), whereas the mean annual dose was 36% lower among Black patients than among White patients (5190 MME vs. 8082 MME). Within systems, the adjusted race differences in measures paralleled the population trends: the annual prevalence of opioid receipt differed little, but the mean annual dose was higher among White patients than among Black patients in 91% of the systems, and at least 15% higher in 75% of the systems. Within individual health systems, Black and White patients received markedly different opioid doses. These system-specific findings could facilitate exploration of the causes and consequences of these differences. (Funded by the National Institute on Aging and the Agency for Healthcare Research and Quality.)