Title

Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition

UMMS Affiliation

Department of Population and Quantitative Health Sciences; Graduate School of Biomedical Sciences

Publication Date

2020-03-26

Document Type

Article

Disciplines

Epidemiology | Geriatrics | Health Services Administration | Health Services Research | Neoplasms | Pain Management | Race and Ethnicity

Abstract

OBJECTIVES: To estimate pain reporting among residents with cancer in relation to metropolitan area segregation and NH racial and ethnic composition.

DESIGN: Cross-sectional study.

SETTING AND PARTICIPANTS: 383,757 newly admitted black (B), Hispanic (H), or white (W) residents with cancer in 12,096 US NHs (2011-2013).

METHODS: Using the Minimum Data Set 3.0, pain in past 5 days was determined by self-report or use of pain management. The Theil entropy index, a measure of metropolitan area segregation, was categorized [high (up to 0.20), very high (0.20-0.30), or extreme (0.30-0.53)].

RESULTS: Pain prevalence decreased across segregation level (black: high = 77%, very high = 75%, extreme = 72%; Hispanic: high = 79%, very high = 77%, extreme = 70%; white: high = 80%, very high = 77%, extreme = 74%). In extremely segregated areas, all residents were less likely to have recorded pain [adjusted prevalence ratios: blacks, 4.6% less likely, 95% confidence interval (CI) 3.1%-6.1%; Hispanics, 6.9% less likely, 95% CI 4.2%-9.6%; whites, 7.4% less likely, 95% CI 6.5%-8.2%] than in the least segregated areas. At all segregation levels, pain was recorded more frequently for residents (black or white) in predominantly white ( > 80%) NHs than in mostly black ( > 50%) NHs or residents (Hispanic or white) in predominantly white NHs than mostly Hispanic ( > 50%) NHs.

CONCLUSIONS AND IMPLICATIONS: We observed decreased pain recording in metropolitan areas with greater racial and ethnic segregation. This may occur through the inequitable distribution of resources between NHs, resident-provider empathy, provider implicit bias, resident trust, and other factors.

Keywords

Cancer, nursing homes, pain, racial and ethnic segregation

DOI of Published Version

10.1016/j.jamda.2020.02.001

Source

Jesdale BM, Mack DS, Forrester SN, Lapane KL. Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition. J Am Med Dir Assoc. 2020 Mar 26:S1525-8610(20)30184-5. doi: 10.1016/j.jamda.2020.02.001. Epub ahead of print. PMID: 32224259. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Medical Directors Association

PubMed ID

32224259

Related Resources

Link to Article in PubMed

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