Racial, Age, & Gender Disparities in the Prehospital Treatment of Pain
Poster #: 014
Session/Time: A
Author:
Mackenzie Kaitlynn Leilani Peeke, BA, MS
Mentor:
John David Landon, BS, MD
Research Type: Educational
Abstract
INTRODUCTION:
Acute pain relief has been recognized as a fundamental human right, yet up to 80% of patients in some settings receive inadequate treatment. Evidence consistently shows that racial and ethnic minorities are disproportionately affected by undertreatment of pain. However, little is known about disparities in prehospital pain management by emergency medical services (EMS) providers. This study aimed to retrospectively assess whether racial, age, or gender disparities exist in the administration of analgesia within a regional EMS system.
METHODS:
We conducted a retrospective review of a Tidewater EMS Council (TEMS) regional subset of the National Emergency Medical Services Information System (NEMSIS) database from June 1 to December 31, 2021. Consecutive patient records meeting regional pain management protocol criteria were included: pain score >5, traumatic or nontraumatic mechanism, Glasgow Coma Scale ≥13, systolic blood pressure >90 mmHg, and age ≥15 years. Data abstraction was performed by state-employed epidemiologists blinded to study objectives, and provided as a de-identified CSV file. Analgesics permitted in the TEMS region included intravenous morphine, fentanyl, and ketamine. Multivariate logistic regression was used to evaluate associations between analgesic administration and patient age, gender, and race.
RESULTS:
A total of 14,454 patients met inclusion criteria. The cohort was 47.5% Black, 47.3% White, 2.6% Latino, 1.2% Asian/Pacific Islander, and 0.2% Native American; 56.8% were female and 43.1% male. Age distribution was 18-24 years (8.3%), 25-64 years (59.3%), and ≥65 years (32.4%). Analgesic administration differed significantly by race (p < 0.0001) and age (p = 0.0250), but not gender (p = 0.5193). In multivariate models, Black patients had lower odds of receiving analgesia than White patients (OR 0.772, 95% CI 0.712-0.838), and patients aged 18-24 also had reduced odds (OR 0.713, 95% CI 0.609-0.834). Male patients were more likely than females to receive medication (OR 1.221, 95% CI 1.130-1.320). After adjusting for potential confounders (pain score, trauma status, level of care, time of day, GCS, systolic blood pressure), these associations persisted: Black patients (OR 0.696, 95% CI 0.640-0.756) and younger patients (OR 0.821, 95% CI 0.699-0.965) had lower odds of receiving analgesia, whereas male patients had higher odds (OR 1.232, 95% CI 1.138-1.333). Among patients with pain scores ≥7, adjusted models again showed reduced odds for Black patients (OR 0.686, 95% CI 0.624-0.756) and mixed-race patients (OR 0.425, 95% CI 0.228-0.795), and higher odds for males (OR 1.220, 95% CI 1.113-1.337). No significant differences were observed in other groups.
CONCLUSION:
In this regional EMS cohort, significant disparities were observed in prehospital pain management. Black patients consistently had lower odds of receiving analgesia compared with White patients, even after adjusting for pain severity and clinical factors. Younger adults (18-24 years) were also less likely to receive pain medications, whereas males had higher odds of treatment compared with females. These disparities persisted in patients reporting high pain scores (≥7). The findings highlight the need for targeted interventions to address inequities in prehospital pain management and ensure guideline-concordant care for all patients.
Acute pain relief has been recognized as a fundamental human right, yet up to 80% of patients in some settings receive inadequate treatment. Evidence consistently shows that racial and ethnic minorities are disproportionately affected by undertreatment of pain. However, little is known about disparities in prehospital pain management by emergency medical services (EMS) providers. This study aimed to retrospectively assess whether racial, age, or gender disparities exist in the administration of analgesia within a regional EMS system.
METHODS:
We conducted a retrospective review of a Tidewater EMS Council (TEMS) regional subset of the National Emergency Medical Services Information System (NEMSIS) database from June 1 to December 31, 2021. Consecutive patient records meeting regional pain management protocol criteria were included: pain score >5, traumatic or nontraumatic mechanism, Glasgow Coma Scale ≥13, systolic blood pressure >90 mmHg, and age ≥15 years. Data abstraction was performed by state-employed epidemiologists blinded to study objectives, and provided as a de-identified CSV file. Analgesics permitted in the TEMS region included intravenous morphine, fentanyl, and ketamine. Multivariate logistic regression was used to evaluate associations between analgesic administration and patient age, gender, and race.
RESULTS:
A total of 14,454 patients met inclusion criteria. The cohort was 47.5% Black, 47.3% White, 2.6% Latino, 1.2% Asian/Pacific Islander, and 0.2% Native American; 56.8% were female and 43.1% male. Age distribution was 18-24 years (8.3%), 25-64 years (59.3%), and ≥65 years (32.4%). Analgesic administration differed significantly by race (p < 0.0001) and age (p = 0.0250), but not gender (p = 0.5193). In multivariate models, Black patients had lower odds of receiving analgesia than White patients (OR 0.772, 95% CI 0.712-0.838), and patients aged 18-24 also had reduced odds (OR 0.713, 95% CI 0.609-0.834). Male patients were more likely than females to receive medication (OR 1.221, 95% CI 1.130-1.320). After adjusting for potential confounders (pain score, trauma status, level of care, time of day, GCS, systolic blood pressure), these associations persisted: Black patients (OR 0.696, 95% CI 0.640-0.756) and younger patients (OR 0.821, 95% CI 0.699-0.965) had lower odds of receiving analgesia, whereas male patients had higher odds (OR 1.232, 95% CI 1.138-1.333). Among patients with pain scores ≥7, adjusted models again showed reduced odds for Black patients (OR 0.686, 95% CI 0.624-0.756) and mixed-race patients (OR 0.425, 95% CI 0.228-0.795), and higher odds for males (OR 1.220, 95% CI 1.113-1.337). No significant differences were observed in other groups.
CONCLUSION:
In this regional EMS cohort, significant disparities were observed in prehospital pain management. Black patients consistently had lower odds of receiving analgesia compared with White patients, even after adjusting for pain severity and clinical factors. Younger adults (18-24 years) were also less likely to receive pain medications, whereas males had higher odds of treatment compared with females. These disparities persisted in patients reporting high pain scores (≥7). The findings highlight the need for targeted interventions to address inequities in prehospital pain management and ensure guideline-concordant care for all patients.