Racial Disparities in Pain Management in Primary Care

Last updated: 07-19-2020

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Racial Disparities in Pain Management in Primary Care

SPSS for Windows Version 16.0 (2007; SPSS Inc., Chicago, IL) was used for all analyses. Descriptive statistics were computed to describe the demographic and clinical variables of the sample. Mann-Whitney U-tests were used to compare African Americans and Caucasians on ordered variables, whereas the Fisher exact test and exact p-values were used to compare African Americans and Caucasians on unordered categorical variables. The Serlin-Harwell Aligned-Ranked Procedure (SHARP), a non-parametric regression analysis technique appropriate for non-normally distributed data (Serlin & Harwell, 2004), was used to test for differences between the medians of African Americans and Caucasians on pain outcomes: pain management composite score and QOL composite score (Serlin & Harwell, 2004). Each analysis was allotted a Type I error rate of 0.05. Further, a series of multiple regression analyses were used to test for mediation based on the joint significance test approach (MacKinnon, Lockwood, Hoffman, West, & Sheets, 2002). The joint significance approach to mediation is the best of the all the causal steps approaches because it has more statistical power and the lowest Type I error rate (Krause et al., 2010). lists the variables tested in the model. Evidence of mediation effects was deduced when tests of the race – perceived discrimination path (α), perceived discrimination – hopelessness path (β), and hopelessness – pain management path (γ) were all significant. To test the α path, age, income, education, and disability were used as covariates, race and gender, were used as the independent variables, and perceived discrimination was the dependent variable. In testing the β path, the pooled within-group relationship between perceived discrimination and hopelessness was evaluated, controlling for covariates, with race and gender as independent variables. To test the γ path, the pooled within-group relationship between hopelessness and pain management was examined, controlling for perceived discrimination and covariates, with race, gender as independent variables. Further, the pain management – QOL path (δ) was examined. In testing the δ path, the pooled within-group relationship between pain management and QOL was examined using the pain management composite score as the independent variable and QOL composite score as the dependent variable, controlling for perceived discrimination, hopelessness, race, gender, and covariates– age, income, education, and disability. Paths were tested using the SHARP procedure. Each analysis was assigned a Type I error rate of 0.05.

Comparison of African Americans and Caucasians on Demographic and Clinical Variables African Americans and Caucasians were compared on demographic and clinical variables (). We found that African Americans earned less income than Caucasians Mann-Whitney U = 48388.00, n1 = 691, n2 = 201, p < .001, α = .35 (α is a measure of stochastic superiority that indicates the probability that an observation from one population will exceed an observation from another population; here, α = .35 indicates that the probability is .65 that an African American will have lower income than a Caucasian), and had fewer years of education than Caucasians, Mann-Whitney U = 42845.00, n1 = 691, n2 = 201, p < .001, α = .31 (probability is .69 that an African Americans will have fewer years of education). There was a statistically significant difference between African Americans and Caucasians regarding employment X(1, N = 892) = 56.69, p < .001, φ = .25. Greater proportions of Caucasians were working a full-time job (36.2%) or part-time job (9.6%) than the proportions of African Americans working a full-time job (14.4%) or part-time job (4.5%). Greater proportions of African Americans were retired/disabled (66.7%) or unemployed (10.4%) than the proportions of Caucasians who were retired/disabled (38.8%) or unemployed (9.7%). There were no significant differences between African Americans and Caucasian on median age and gender. Further, African Americans were significantly more likely to report chronic pain-related disability than Caucasians [X(1, N = 892) = 56.46, p < .001, φ = .25]. There were no significant differences between African Americans and Caucasians on years since pain diagnosis, years since first visit to pain clinic, and years since first opioid use. There was a statistically significant difference between the medians of African Americans and Caucasians on pain management composite scores SHARP [X(1, N = 890) = 38.94, p < .001, Squared Partial Correlation Coefficient = .04] controlling for age, gender, income, education, and disability. The direction of the slope indicates that African Americans reported worse pain management scores than Caucasians. Further, race was a significant predictor of QOL SHARP [X(1, N = 889) = 10.76, p < .001, Squared Partial Correlation Coefficient = .02] controlling for age, income, education, disability, and gender. The race slope indicated that African Americans reported lower QOL scores than Caucasians. and provide the description of variables included for testing each path in the model. The race–perceived discrimination path (α) was significant, which indicated that race was a significant predictor of perceived discrimination SHARP [X(1, N = 891) = 5.57, p = .02, Squared Partial Correlation Coefficient = .01]. The slope for race indicated that African Americans reported more perceived discrimination than Caucasians. The perceived discrimination – hopelessness path (β) was significant, demonstrating that perceived discrimination was a significant predictor of hopelessness SHARP [X(1, N = 890) = 39.87, p < .001, Squared Partial Correlation Coefficient = .05]. The slope for perceived discrimination indicated that higher scores on perceived discrimination were associated with higher hopelessness scores. The hopelessness – pain management path (γ) was significant, which shows that hopelessness was a significant predictor of pain management SHARP [X(1, N = 890) = 42.11, p < .001, Squared Partial Correlation Coefficient = .05]. The slope for hopelessness indicated that lower hopelessness was related to better pain management. The test of delta path (δ) involved using the pain management composite score as the independent variable and QOL composite score as the dependent variable. This path was significant SHARP [X(1, N = 888) = 54.96, p < .001, Squared Partial Correlation Coefficient = .06], which indicates that pain management was a significant predictor of QOL. The slope for pain management showed that worse pain management scores were associated with lower QOL.


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