Racial and ethnic disparities in the management of acute pain in US emergency departments: Meta-analysis and systematic review

Objective: This review aims to quantify the effect of minority status on analgesia use for acute pain management in US Emergency Department (ED) settings. Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology to perform a review of studies from 1990 to 2018 comparing racial and ethnic differences in the administration of analgesia for acute pain. Studies were included if they measured analgesia use in white patients compared to a racial minority in the ED and studies were excluded if they focused primarily on chronic pain, case reports and survey studies. Following data abstraction, a meta-analysis was performed using fixed and random-effect models to determine primary outcome of analgesia administration stratified by racial and ethnic classification. Results: 763 articles were screened for eligibility and fourteen studies met inclusion criteria for qualitative synthesis. The total study population included 7070 non-Hispanic White patients, 1538 Hispanic, 3125 Black, and 50.3% female. Black patients were less likely than white to receive analgesia for acute pain: OR 0.60 [95%-CI, 0.43-0.83, random effects model]. Hispanics were also less likely to receive analgesia: OR 0.75 [95%-CI, 052-1.09]. Conclusion: This study demonstrates the presence of racial disparities in analgesia use for the management of acute pain in US EDs. Further research is needed to examine patient reported outcomes in addition to the presence of disparities in other groups besides Black and Hispanic. (C) 2019 Elsevier Inc. All rights reserved.