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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2023

04-09-2023 | Opioids | Gastrointestinal Oncology

Association of Race/Ethnicity, Persistent Poverty, and Opioid Access Among Patients with Gastrointestinal Cancer Near the End of Life

Authors: Muhammad Musaab Munir, MBBS, Selamawit Woldesenbet, MS, PhD, Yutaka Endo, MD, PhD, Aslam Ejaz, MD, Jordan M. Cloyd, MD, Samilia Obeng-Gyasi, MD, MPH, Mary Dillhoff, MD, Brittany Waterman, MD, Jillian Gustin, MD, Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.), FRCSEd (Hon.)

Published in: Annals of Surgical Oncology | Issue 13/2023

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Abstract

Background

Social determinants of health (SDoH) can impact access to healthcare. We sought to assess the association between persistent poverty (PP), race/ethnicity, and opioid access among patients with gastrointestinal cancer near the end-of-life (EOL).

Methods

SEER-Medicare patients with gastric, liver, pancreatic, biliary, colon, and rectal cancer were identified between 2008 and 2016 near EOL, defined as 30 days before death or hospice enrolment. Data were linked with county-level poverty from the American Community Survey and the US Department of Agriculture (2000–2015). Counties were categorized as never high-poverty (NHP), intermittent high-poverty (IHP) and persistent poverty (PP). Trends in opioid prescription fills and daily dosages (morphine milligram equivalents per day) were examined.

Results

Among 48,631 Medicare beneficiaries (liver: n = 6551, 13.5%; pancreas: n = 13,559, 27.9%; gastric: n = 5486, 1.3%; colorectal: n = 23,035, 47.4%), there was a steady decrease in opioid prescriptions near EOL. Black, Asian, Hispanic, and other racial groups had markedly decreased odds of filling an opioid prescription near EOL (Black: OR 0.84, 95% CI 0.79–0.90; Asian: OR 0.86, 95% CI 0.79–0.94; Hispanic: OR 0.90, 95% CI 0.84–0.95; Other: OR 0.83, 95% CI 0.74–0.93; all p < 0.05). Even after filling an opioid prescription, this subset of patients received lower daily doses versus White patients (Black: −16.5 percentage points, 95% CI −21.2 to −11.6; Asian: −11.9 percentage points, 95% CI −18.5 to −4.9; Hispanic: −19.1 percentage points, 95%CI −23.5 to −14.6; all p < 0.05). The disparity in opioid access and average daily doses among was attenuated in IHP/PP areas for Asian, Hispanic, and other racial groups, yet exacerbated among Black patients.

Conclusions

Race/ethnicity-based disparities in EOL pain management persist with SDoH-based variations in EOL opioid use. In particular, PP impacted EOL opioid access and utilization.
Appendix
Available only for authorised users
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Metadata
Title
Association of Race/Ethnicity, Persistent Poverty, and Opioid Access Among Patients with Gastrointestinal Cancer Near the End of Life
Authors
Muhammad Musaab Munir, MBBS
Selamawit Woldesenbet, MS, PhD
Yutaka Endo, MD, PhD
Aslam Ejaz, MD
Jordan M. Cloyd, MD
Samilia Obeng-Gyasi, MD, MPH
Mary Dillhoff, MD
Brittany Waterman, MD
Jillian Gustin, MD
Timothy M. Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon.), FRCSEd (Hon.)
Publication date
04-09-2023
Publisher
Springer International Publishing
Keywords
Opioids
Opioids
Published in
Annals of Surgical Oncology / Issue 13/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-023-14218-4

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