Is Race/Ethnicity Related to Presence or Severity of Pain in Colorectal and Lung Cancer?

Posted in Articles, Health/Medicine/Genetics, United States on 2014-04-25 07:46Z by Steven

Is Race/Ethnicity Related to Presence or Severity of Pain in Colorectal and Lung Cancer?

Journal of Pain and Symptom Management
Published online: 2014-04-18
DOI: 10.1016/j.jpainsymman.2014.02.005

Kathryn A. Martinez, PhD, MPH, Postdoctoral Fellow
CanSORT (Cancer Surveillance & Outcomes Research Team)
Ann Arbor VA Health Services Research & Development Center,
University of Michgan, Ann Arbor

Claire F. Snyder, PhD, Associate Professor of Internal Medicine
Johns Hopkins Univesity Shchool of Medicine, Baltimore, Maryand

Jennifer L. Malin, MD, PhD
Wellpoint, Thousand Oaks, Calfornia; Jonsson Comprehensive Cancer Center and David Geffen School of Medicine, University of California, Los Angeles

Sydney M. Dy, MD, MSc, Physician Leader, Duffey Pain and Palliative Care Program, Hopkins Kimmel Cancer Center; Associate Professor
Deparmemt of Health Management and Policy
Johns Hopkins Bloomberg School of Public Health

Context

Developing interventions to address racial/ethnic cancer pain disparities requires exploration of the role of socioeconomic status, health status, and pain severity from the time of diagnosis.

Objectives

To examine patterns of disparities in cancer pain by evaluating differences by race/ethnicity in the odds of reporting pain and in pain severity, controlling for key patient-level covariates.

Methods

This study used data from a nationally representative cohort of colorectal and lung cancer patients. Multivariable logistic regression was conducted to examine the relationship between race/ethnicity and reporting pain. Multivariable linear regression was then conducted, among those who reported pain, to determine differences in pain severity by race/ethnicity.

Results

The cohort included 5,761 individuals (14% black, 7% Hispanic/Latino, 6% Asian or Pacific Islander, and 3% multiracial) among whom 48% reported pain. The adjusted odds of reporting differed only for multiracial patients, who were more likely to report pain than whites (OR:1.54; p=0.036). However, among those with pain, severity was higher for black patients (β=6.6; p≤0.001) and multiracial patients (β=4.5; p=0.036) relative to white patients. Lower educational attainment, depressed affect, and lower levels of wealth were also associated with higher pain severity.

Conclusion

While the odds of experiencing pain differed only for multiracial patients, among those reporting pain, both blacks and multiracial individuals reported higher pain severity than whites. Sociodemographic status, health status, and depression were associated with severity but did not explain the disparity. Interventions to address these disparities will need to address reported severity as well as patient-level factors.

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