As the U.S. continues to struggle with issues in equity for people of all races, it’s no surprise that there are similar inequalities in terms of health. Anyone who suffers from chronic pain deserves the same compassion and treatment options that all other patients receive. We’ve talked before about some of the inequalities in care among genders; this post covers those who are being underserved by the larger medical community. By shining a light on these stories, we hope to show how comprehensive and compassionate chronic pain treatment should be extended to all patients.
Chronic pain in the African American community
African Americans experience unique health challenges. These may be a result of a combination of factors that include lower socioeconomic status, geographic distribution of the population, underlying prejudices, and access to quality healthcare resources.
According to the Department of Health and Human Services fact sheet for African Americans, some of these challenges include:
- The highest mortality rate of any racial and ethnic group for cancer generally and for most major cancers individually, including stomach, liver, prostate, and colon cancers
- A 40% higher chance of death due to breast cancer even though the rate of breast cancer for African American women is 10% lower than non-Hispanic whites
- Uncontrolled high blood pressure at an 18% higher rate than non-Hispanic whites and a 40% increased incidence of high blood pressure in general
- An infant mortality rate that is 2.3 times the rate for non-Hispanic whites, with African American infants dying of low birthweight-related issues at four times the rate of white infants
A crucial part of healthcare is insurance that provides access to preventative care, and African Americans are 55% more likely to be uninsured than non-Hispanic white Americans. This low rate of insurance contributes to higher rates of mortality and more serious illness in African American populations. The rates of insurance vary widely across geographic regions, with African Americans less likely to have health insurance in the south than anywhere else in the country. This gap was closing between 2013 and 2016, with 18% uninsured in 2013 and 11% in 2016, but recent policy legal updates may change that.
Quality of care
Not only do African Americans have less access to care due to a lower rate of insurance, but the care they do access is of lower quality than care given to non-Hispanic whites.
In two studies that examined a doctor’s unconscious bias, researchers found that doctors who demonstrated bias in a task were providing care that was rated much lower among their African American patients. This was supported by research that indicated higher death rates for lung cancer were present in highly segregated counties in Colorado, even when controlling for income and smoking prevalence.
Awori J. Hayanga, MD, MPH, the study’s lead author, believes that it is not just unequal access that is the issue, and adding more doctors or providing more insurance won’t necessarily fix the problem. Hayanga notes:
“It is the lack of access, the deprivation, but also the intangible sociocultural aspects of it. One, you may not have the screening services. Two, if you do have screening services, do you have the specialists to see? Will the population dealing with this trust the system enough to go or is there a cultural barrier that stops them from going to that second phase of their care? It isn’t one thing — it’s a complex equation where enough things collude to make it happen.”
Different chronic pain treatment access
When it comes to chronic pain diagnosis and treatment, these barriers of access and bias exist and extend to checkups and monitoring of pain treatment plans, especially when it comes to opioid prescriptions. Lead investigator Leslie R.M. Hausmann, PhD at the Center for Health Equity Research and Promotion in the VA Pittsburgh Healthcare System and assistant professor of medicine at the University of Pittsburgh, looked at the electronic records of 1,646 white patients and 253 black patients who filled prescriptions for pain that was unrelated to cancer.
Although there were differences in some characteristics (e.g., white patients were older and more likely to be married), there was no difference in their history of substance abuse. However, researchers found that black patients were more likely to be tested for drug levels than white patients, even though pain levels were taken for black patients less frequently.
Additionally, black patients were less likely to be recommended to a pain specialist, but more likely to be referred for substance abuse assessment.
Dr. Hausmann concludes that:
“The emerging picture is that black patients who are able to overcome the barriers to securing a prescription for opioid medications may still be subjected to differential monitoring and follow-up treatment practices that could impact the effectiveness of their pain management. Addressing disparities in opioid monitoring practices may be a previously neglected route to reducing racial disparities in pain management.”
Bias in clinical trials
When it comes to developing new drugs for some of the diseases most prevalent in the African American community, bias even exists in participation in clinical trials. Researchers at H. Lee Moffitt Cancer Center & Research Institute found that whites participated in genetic clinical studies at a rate that was twice that of African Americans. In clinics and universities that were well-supported, participation rates in these studies were about equal among whites and non-whites, but at smaller institutions, representation was grossly unequal.
Howard L. McLeod, PharmD, medical director of the DeBartolo Family Personalized Medicine Institute at Moffitt, pointed out that this inequality may lead to ineffective treatments based on misrepresented genetics:
“As the field of oncology moves to biomarker-driven therapy, there is a concern that important minority groups are being inadvertently left out of the very research that will find the ‘right’ marker to guide therapy for people in their community.”
Chronic pain in the Latino community
The rapidly growing U.S. Latino population faces similar barriers to health care. Chronic pain, in particular, is undertreated in the Latino community, leaving many needlessly suffering from life-altering pain.
Barriers to care for Latino population
Hispanics face cultural impediments to finding the health care they need.
High poverty rates and low education levels make it difficult for Latinos to find the medical care they need, or even access health-related information. The community’s traditional cultural beliefs may often result in fear around topics like cancer, leading to low rates of screening for certain diseases.
Like white people, Latinos are most likely to die from cancer or heart disease, although cancer is the top killer among Latinos and No. 2 in whites, according to the Centers for Disease Control and Prevention (CDC).
Other causes of death are far more common in Latinos. For exampl