Abstract：
BACKGROUND: Pain is ubiquitous, yet understudied. The objective of this study was to analyze inequities in pain assessment and management for hospitalized older adults focusing on demographic and geriatric-related variables.
METHODS: This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric-related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end-of-life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME).
RESULTS: A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70-0.80), Latinx (OR 0.90, 95% CI 0.83-0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64-0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66-0.74) had lower odds of a numeric assessment, compared with English-speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end-of-life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77-96), Asian patients (55 MME, 95% CI 46-65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids.
CONCLUSIONS: Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.
METHODS: This was a retrospective cohort study from January 2013 through September 2021 of all adults 65 years or older on the general medicine service at UCSF Medical Center. Primary exposures included (1) demographic variables including race/ethnicity and limited English proficiency (LEP) status and (2) geriatric-related variables including age, dementia or mild cognitive impairment diagnosis, hearing or visual impairment, end-of-life care, and geriatrics consult involvement. Primary outcomes included (1) adjusted odds of numeric pain assessment versus other assessments and (2) adjusted opioids administered, measured by morphine milligram equivalents (MME).
RESULTS: A total of 15,809 patients were included across 27,857 hospitalizations with 1,378,215 pain assessments, with a mean age of 77.8 years old. Patients were 47.4% White, 26.3% with LEP, 49.6% male, and 50.4% female. Asian (OR 0.75, 95% CI 0.70-0.80), Latinx (OR 0.90, 95% CI 0.83-0.99), and Native Hawaiian or Pacific Islander (OR 0.77, 95% CI 0.64-0.93) patients had lower odds of a numeric assessment, compared with White patients. Patients with LEP (OR 0.70, 95% CI 0.66-0.74) had lower odds of a numeric assessment, compared with English-speaking patients. Patients with dementia, hearing impairment, patients 75+, and at end-of-life were all less likely to receive a numeric assessment. Compared with White patients (86 MME, 95% CI 77-96), Asian patients (55 MME, 95% CI 46-65) received fewer opioids. Patients with LEP, dementia, hearing impairment and those 75+ years old also received significantly fewer opioids.
CONCLUSIONS: Older, hospitalized, general medicine patients from minoritized groups and with geriatric-related conditions are uniquely vulnerable to inequitable pain assessment and management. These findings raise concerns for pain underassessment and undertreatment.
摘要：
背景：疼痛无处不在，但研究不足。这项研究的目的是分析住院老年人疼痛评估和管理方面的不平等，重点是人口统计学和老年相关变量。
方法：这是一项回顾性队列研究，从2013年1月到2021年9月，在UCSF医疗中心接受普通医学服务的所有65岁或以上的成年人。主要暴露包括（1）人口统计学变量，包括种族/民族和有限的英语水平（LEP）状态和（2）老年相关变量，包括年龄，痴呆或轻度认知障碍诊断，听力或视力障碍，临终关怀,和老年医学咨询参与。主要结果包括（1）调整后的数字疼痛评估与其他评估的几率和（2）调整后的阿片类药物，通过吗啡毫克当量（MME）测量。
结果：共有15,809名患者纳入了27,857例住院患者的1,378,215项疼痛评估，平均年龄为77.8岁。患者为47.4%的白人，LEP为26.3％，49.6%男性,50.4%为女性。亚洲（OR0.75，95%CI0.70-0.80），拉丁裔（OR0.90，95%CI0.83-0.99），夏威夷原住民或太平洋岛民（OR0.77，95％CI0.64-0.93）患者的数字评估几率较低，与白人患者相比。LEP患者（OR0.70，95％CI0.66-0.74）的数值评估几率较低，与说英语的患者相比。痴呆症患者，听力障碍,患者75+，并且在生命结束时都不太可能接受数字评估。与白人患者(86名MME，95%CI77-96），亚洲患者(55名MME，95%CI46-65）接受的阿片类药物较少。LEP患者,痴呆症,听力障碍和75岁以上的人接受的阿片类药物也明显减少。
结论：年龄较大，住院,来自小型人群和老年相关疾病的普通医学患者特别容易受到不公平的疼痛评估和管理的影响。这些发现引起了人们对疼痛评估不足和治疗不足的担忧。
方法：这是一项回顾性队列研究，从2013年1月到2021年9月，在UCSF医疗中心接受普通医学服务的所有65岁或以上的成年人。主要暴露包括（1）人口统计学变量，包括种族/民族和有限的英语水平（LEP）状态和（2）老年相关变量，包括年龄，痴呆或轻度认知障碍诊断，听力或视力障碍，临终关怀,和老年医学咨询参与。主要结果包括（1）调整后的数字疼痛评估与其他评估的几率和（2）调整后的阿片类药物，通过吗啡毫克当量（MME）测量。
结果：共有15,809名患者纳入了27,857例住院患者的1,378,215项疼痛评估，平均年龄为77.8岁。患者为47.4%的白人，LEP为26.3％，49.6%男性,50.4%为女性。亚洲（OR0.75，95%CI0.70-0.80），拉丁裔（OR0.90，95%CI0.83-0.99），夏威夷原住民或太平洋岛民（OR0.77，95％CI0.64-0.93）患者的数字评估几率较低，与白人患者相比。LEP患者（OR0.70，95％CI0.66-0.74）的数值评估几率较低，与说英语的患者相比。痴呆症患者，听力障碍,患者75+，并且在生命结束时都不太可能接受数字评估。与白人患者(86名MME，95%CI77-96），亚洲患者(55名MME，95%CI46-65）接受的阿片类药物较少。LEP患者,痴呆症,听力障碍和75岁以上的人接受的阿片类药物也明显减少。
结论：年龄较大，住院,来自小型人群和老年相关疾病的普通医学患者特别容易受到不公平的疼痛评估和管理的影响。这些发现引起了人们对疼痛评估不足和治疗不足的担忧。
