Racial disparities in analgesic and psychiatric medication use during end-of-life care in advanced-stage colorectal cancer: A Retrospective Cohort Study.

Abstract

This study examined racial and ethnic disparities in the use of analgesic and psychiatric medications during end-of-life care among Medicare beneficiaries with advanced-stage colorectal cancer. Using the SEER-Medicare linked database from 2005 to 2017, we identified 28,212 patients with stage IV colorectal cancer who died within one year of diagnosis. Multivariable logistic regression models were used to assess differences in medication use by race and ethnicity. Compared to non-Hispanic White patients, Black patients had significantly lower odds of opioid use (adjusted odds ratio [aOR]: 0.86; 95% confidence interval [CI]: 0.80-0.93) and overall analgesic use, while Hispanic patients had higher use of opioids (aOR: 1.12; 95% CI: 1.03-1.22) and non-opioid analgesics (aOR: 1.22; 95% CI: 1.06-1.40). Asian patients had increased non-opioid use (aOR: 1.71; 95% CI: 1.44-2.03) and decreased skeletal muscle relaxant use (aOR: 0.59; 95% CI: 0.43-0.82). Across all minority groups, psychiatric medication use was consistently lower than in non-Hispanic White patients. These disparities persisted after adjusting for demographic, clinical, and socioeconomic factors. Findings highlight the urgent need for equitable, culturally responsive symptom management strategies to improve the quality of end-of-life care in this population.