PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211
PainRelief.com: What is the background for this study?
Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status. Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients.
Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors. Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA. Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.
PainRelief.com: What are the main findings?
Response: We found that African American patients have significantly lower rates of use of pharmacologic and nonpharmacologic treatments when compared to White patients as well as lower rates of all cause hospitalization. Despite lower levels of resource use, we nevertheless found that African American patients all cause healthcare expenditure is significantly higher than in Whites or other race patients because of higher inpatient costs. These differences persisted in multivariable models after controlling for urbanicity, age, presence of moderate to severe OA, and underlying comorbidities.
PainRelief.com: What should readers take away from your report?
Response: There are racial differences in healthcare expenditures, and the use of pharmacologic as well as nonpharmacologic treatments, in patients with hip or knee osteoarthritis. These disparities in healthcare expenses by race persist in a Medicaid population where social economic status is more homogeneous.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Future research is needed to identify the additional factors associated with higher healthcare costs in African American patients.
PainRelief.com: Is there anything else you would like to add?
Response: The limitations of our study include those inherent in any retrospective analysis. As with any claims database we relied on administrative claims data. These data are subject to data coding limitations and data entry error. The presence of a claim for filled prescriptions does not indicate whether the medication was consumed or taken as prescribed. There may also be systematic differences between the study cohorts that account for differences found in healthcare costs and utilization. We were only able to adjust for those characteristics that can be measured from administrative claims.
Stuart Silverman is a consultant to Lilly. Rebecca Robinson is an employee of Lilly.
C Hultman and A Zagar are employees of Lilly
E Packnett, NM Zimmerman and E Lopez Gonzalez are employees of IBM Watson
P Shepman and W Faison are employees of Pfizer
Citation: Pain Week 2021 abstract
Racial variations in healthcare resource use and expenditures in a population of Medicaid patients with knee/hip osteoarthritis
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