Discrepancies in opioid prescription and comorbidity burden in chronic low back pain: The impact of race, ethnicity, and socioeconomic status

Boss Povieng; Alvyn Hernandez Reyes; Yanyu Zhang; Weibin Shi; Hong Wu

doi:10.5055/jom.0914

Authors

Boss Povieng, MD https://orcid.org/0000-0002-4039-9242
Alvyn Hernandez Reyes
Yanyu Zhang, MS
Weibin Shi, MD, PhD
Hong Wu, MD, MS https://orcid.org/0000-0003-3697-8302

DOI:

https://doi.org/10.5055/jom.0914

Keywords:

chronic low back pain, opioids, comorbidity, treatment, socioeconomic hardship

Abstract

Objective: To examine associations between race, comorbidity, opioid and nonopioid treatment burden, and socioeconomic status (SES) in patients with chronic low back pain (CLBP).

Design: A case–control study.

Setting: Tertiary academic system.

Participants: A total of 4,193 subjects with CLBP and 4,193 age-, sex-, race-, and region-matched subjects with nonchronic low back pain participated in this study.

Main outcome measure(s): The primary outcome measures were prescription frequencies of opioid and nonopioid medications as well as nonpharmaceutical interventions. Secondary measures pertained to the prevalence of comorbidities, race, and SES traits.

Results: The median age of the subjects was 55.50 years, with 61.75 percent female distribution, 48.84 percent Black or African American, 30.65 percent White non-Hispanic, and 15.93 percent non-White Hispanic or Latino among the subjects. Black or African American and non-White Hispanic or Latino identity was associated with higher hardship compared to patients identifying as White non-Hispanic (Tukey–Kramer adjusted p-value < 0.0001). Opioid use was significantly higher in the CLBP group (Cochran–Armitage trend test p-value < 0.0001), and there was a significant positive trend between the number of comorbidities and opioids used. As hardship index group (HIG) increased by 1, the expected number of comorbidities increased by a factor of 1.09 (95 percent confidence interval [CI]: 1.06-1.11), and the expected number of treatments increased by a factor of 1.07 (95 percent CI: 1.04-1.09). Physical therapy and spine procedures had a significant negative relationship with hardship.

Conclusions: Higher opioid prescribing behavior, particularly for morphine, hydrocodone, and tramadol, exists in patients with CLBP, especially in patients facing hardship and identifying as Black or African American and non-White Hispanic or Latino. Further prospective studies are needed to strengthen causality.

Author Biographies

Boss Povieng, MD

Resident Physician, Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, Illinois

Alvyn Hernandez Reyes

Medical Student, Rush Medical College, Chicago, Illinois

Yanyu Zhang, MS

Rush University Medical Center Bioinformatics and Biostatistics Core, Chicago, Illinois

Weibin Shi, MD, PhD

Associate Professor, Department of Physical Medicine and Rehabilitation, Penn State Health Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania

Hong Wu, MD, MS

Professor, Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Rush University Medical College, Chicago, Illinois

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