Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD
- PMID: 37698860
- PMCID: PMC10498328
- DOI: 10.1001/jamanetworkopen.2023.33251
Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD
Abstract
Importance: Nonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and structural racism, highlighting the need to understand their receipt of guideline-recommended nonpharmacologic pain therapies, including physical therapy (PT) and chiropractic care.
Objective: To assess differences across racial and ethnic groups in receipt of PT or chiropractic care for chronic low back pain (CLBP) among persons with comorbid OUD.
Design, setting, and participants: This retrospective cohort study used a 20% random sample of national Medicare administrative data from January 1, 2016, to December 31, 2018, to identify fee-for-service community-dwelling beneficiaries with a new episode of CLBP and comorbid OUD. Data were analyzed from March 1, 2022, to July 30, 2023.
Exposures: Race and ethnicity as a social construct, categorized as American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic, non-Hispanic White, and unknown or other.
Main outcomes and measures: The main outcomes were receipt of PT or chiropractic care within 3 months of CLBP diagnosis. The time (in days) to receiving these treatments was also assessed.
Results: Among 69 362 Medicare beneficiaries analyzed, the median age was 60.0 years (IQR, 51.5-68.7 years) and 42 042 (60.6%) were female. A total of 745 beneficiaries (1.1%) were American Indian or Alaska Native; 444 (0.6%), Asian or Pacific Islander; 9822 (14.2%), Black or African American; 4124 (5.9%), Hispanic; 53 377 (77.0%); non-Hispanic White; and 850 (1.2%), other or unknown race. Of all beneficiaries, 7104 (10.2%) received any PT or chiropractic care 3 months after a new CLBP episode. After adjustment, Black or African American (adjusted odds ratio, 0.46; 95% CI, 0.39-0.55) and Hispanic (adjusted odds ratio, 0.54; 95% CI, 0.43-0.67) persons had lower odds of receiving chiropractic care within 3 months of CLBP diagnosis compared with non-Hispanic White persons. Median time to chiropractic care was longest for American Indian or Alaska Native (median, 8.5 days [IQR, 0-44.0 days]) and Black or African American (median, 7.0 days [IQR, 0-42.0 days]) persons and shortest for Asian or Pacific Islander persons (median, 0 days [IQR, 0-6.0 days]). No significant racial and ethnic differences were observed for PT.
Conclusions and relevance: In this retrospective cohort study of Medicare beneficiaries with comorbid CLBP and OUD, receipt of PT and chiropractic care was low overall and lower across most racial and ethnic minority groups compared with non-Hispanic White persons. The findings underscore the need to address inequities in guideline-concordant pain management, particularly among Black or African American and Hispanic persons with OUD.
Conflict of interest statement
Figures
Similar articles
-
Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis.J Pain. 2024 Mar;25(3):742-754. doi: 10.1016/j.jpain.2023.10.003. Epub 2023 Nov 22. J Pain. 2024. PMID: 37820847
-
State Variation in Racial and Ethnic Disparities in Incidence of Triple-Negative Breast Cancer Among US Women.JAMA Oncol. 2023 May 1;9(5):700-704. doi: 10.1001/jamaoncol.2022.7835. JAMA Oncol. 2023. PMID: 36862439 Free PMC article.
-
Association of Rurality, Race and Ethnicity, and Socioeconomic Status With the Surgical Management of Colon Cancer and Postoperative Outcomes Among Medicare Beneficiaries.JAMA Netw Open. 2022 Aug 1;5(8):e2229247. doi: 10.1001/jamanetworkopen.2022.29247. JAMA Netw Open. 2022. PMID: 36040737 Free PMC article.
-
Quantification of race/ethnicity representation in Alzheimer's disease neuroimaging research in the USA: a systematic review.Commun Med (Lond). 2023 Jul 25;3(1):101. doi: 10.1038/s43856-023-00333-6. Commun Med (Lond). 2023. PMID: 37491471 Free PMC article. Review.
-
Structural Racism and Lung Cancer Risk: A Scoping Review.JAMA Oncol. 2024 Jan 1;10(1):122-128. doi: 10.1001/jamaoncol.2023.4897. JAMA Oncol. 2024. PMID: 38032677 Review.
Cited by
-
Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis.J Gen Intern Med. 2024 Jun 3. doi: 10.1007/s11606-024-08799-3. Online ahead of print. J Gen Intern Med. 2024. PMID: 38829451
-
Implementation of eLearning solutions for patients with chronic pain conditions.Digit Health. 2023 Nov 27;9:20552076231216404. doi: 10.1177/20552076231216404. eCollection 2023 Jan-Dec. Digit Health. 2023. PMID: 38033514 Free PMC article.
-
Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis.J Pain. 2024 Mar;25(3):742-754. doi: 10.1016/j.jpain.2023.10.003. Epub 2023 Nov 22. J Pain. 2024. PMID: 37820847
References
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Medical