Racial disparities in opioid prescriptions for fractures in the pediatric population

Am J Emerg Med. 2022 Jan:51:210-213. doi: 10.1016/j.ajem.2021.10.017. Epub 2021 Oct 14.


Background and objectives: Racial disparities have been well documented in literature regarding pain management. However, few studies have focused on its effect in the pediatric population. This study seeks to examine the relationship between race and opioid prescription patterns for children with fractures.

Methods: A retrospective study was conducted by reviewing all analgesic prescriptions of discharged pediatric patients (ages 0-21, median 10 years) from a large children's hospital over a five-year period. Multiple logistic regression analysis was applied to examine racial differences in opioid prescriptions for patients with long bone fractures after adjusting for sex, age, length of stay, and payer type.

Results: 58,402 analgesic prescriptions were reviewed in this study; 5061 were given for the primary discharge diagnosis of "fracture" of any bone. Overall, 52% of analgesics prescribed for this diagnosis were opioid medications. The relative frequency of opioid prescriptions was 48.7% in Hispanic White patients and 63.1% in non-Hispanic White patients. The odds ratio for non-Hispanic White patients to be prescribed an opioid medication was 1.44 (CI 1.20-1.73) compared to Black patients and to Hispanic White patients after adjustment for sex, age, length of hospital stay, and payer type. The same racial disparity pattern was observed in patients regardless of long bone fracture location.

Conclusions: Racial bias is suggested in opioid prescription patterns, even in the pediatric population, which may have untoward negative downstream effects. This study delineates the need for improved and standardized methods to adequately treat pain and reduce variations in prescriber habits.

Keywords: Drug prescriptions; Health disparity; Opioids; Pediatrics; Racial bias.

MeSH terms

  • Adolescent
  • Analgesics, Opioid / therapeutic use*
  • California
  • Child
  • Child, Preschool
  • Female
  • Fractures, Bone / complications
  • Healthcare Disparities / ethnology*
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Pain / drug therapy*
  • Pain / etiology
  • Pain Measurement
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Racial Groups*
  • Retrospective Studies
  • Young Adult


  • Analgesics, Opioid