Disparities in diagnosis and management of chronic overlapping pain conditions in an observational study of medicare beneficiaries

Abstract

Disparities in care and management of pain among racial groups have been demonstrated in various studies. Chronic overlapping pain conditions (COPCs) have yet to be examined. This was an observational cohort study of Medicare beneficiaries from 2018–2020 analyzing COPC diagnosis rates and prescription claims. Nationally representative 20% sample of Medicare beneficiaries from 2018–2020. Medicare beneficiaries ≥ 66 years of age in 2019 were included if they had ≥ nine months of A/B/D coverage in 2018–2020. Beneficiaries were excluded if they had Medicare Advantage or end-stage renal disease. Prevalence of COPC diagnosis using validated ICD-10 codes in Medicare beneficiaries and disparities in diagnosis and management. In 2019, 2,573,165 patients were included in the analysis; 87% were White, 8% Black, and 1.7% Asian. COPC diagnosis prevalence in Medicare beneficiaries was more than 10% (n=273,996). Black (odds ratio [OR], 0.89 [95% CI, 0.88–0.91]) and Asian (OR, 0.68 [95% CI, 0.66–0.71]) patients were less likely to have a COPC diagnosis. The incidence of a new COPC diagnosis was 11.4% (n=31,281) among Medicare beneficiaries; only 24.1% (n=7541) received COPC-targeted prescriptions. Black (OR, 1.13 [95% CI, 1.02–1.26]), and Asian (OR, 1.32 [95% CI, 1.06–1.63]) beneficiaries were more likely to receive COPC-targeted prescriptions. Black (OR, 1.12 [95% CI, 1.01–1.25]) beneficiaries were more likely to receive opioids. Examination of associations, not causations or reasons underlying the identified disparities. The prevalence of COPC diagnosis in Medicare beneficiaries was 10%, but only one-quarter of those received COPC-targeted prescriptions. Disparities in COPCs persist into COPCs for Black beneficiaries.

Perspective

The study examines the prevalence and management of COPCs in older adults using Medicare data. It found racial disparities in diagnosis and prescriptions, with Black and Asian beneficiaries less likely to receive a diagnosis. Opioid use remains high despite known ineffectiveness, highlighting the need for better pain management strategies.