Disparities in Prehospital Pain Control among the Hispanic/Latino Population in North Carolina

Introduction—Previous studies suggest socioeconomic disparities in pain control among emergency department and prehospital patients, including age, race and gender. However, such disparities have not been thoroughly investigated on a statewide basis among prehospital Hispanic/Latino trauma patients.

Objective—To quantify paramedic narcotic administration rates among Hispanic/Latino trauma patients.

Methods—A retrospective observational study of prehospital pain control using the North Carolina Prehospital Care Reporting System (PREMIS) data from July 1, 2012 to Dec. 31, 2012. Inclusion criteria consisted of adult (≥16) trauma patients with an initial pain score ≥7 which required narcotic analgesia per treatment protocols. The analgesics of interest included hydrocodone, morphine sulfate, hydromorphone, meperidine or fentanyl. Logistic regression was used to calculate the adjusted odds ratio (OR) for racial/ethnic variation (Caucasian, Hispanic/Latino, non-Hispanic/Latino minority) in the likelihood of narcotic administration while controlling for the potentially confounding variables of patient age, blood pressure, respiratory rate and GCS.

Results—A total of 15,121 patients met the inclusionary criteria. Of these, 44.5% were male, 70.2% Caucasian, 1.9% Hispanic/Latino, and 27.9% non-Hispanic/Latino minority. Overall, 28.0% of the sample received a narcotic analgesic. The mean age was 49.0 (±21.3), and the mean pain score was 8.8 (±1.1). Compared to Caucasians, Hispanic/Latino patients were significantly less likely to receive narcotic analgesia (OR 0.59, p<0.01), whereas the disparity was even more pronounced in non-Hispanic/Latino minorities (OR 0.43, p<0.01). Additionally, females were less likely to receive narcotics than males (OR 0.75, p<0.01). Narcotic administration was more likely with increasing pain scale ratings (OR 1.54, p<0.01).

Conclusion—This study found similar disparities in North Carolina prehospital pain management practices among trauma patients as smaller regional studies have suggested in regards to race and gender. Additional investigation is warranted to determine the rationale for low rates of narcotic administration and the lower rates among minorities and females in particular.