Racial discrimination in medical care settings and opioid pain reliever misuse in a U.S. cohort: 1992 to 2015

Autoři: Samuel L. Swift aff001;  M. Maria Glymour aff002;  Tali Elfassy aff003;  Cora Lewis aff004;  Catarina I. Kiefe aff005;  Stephen Sidney aff006;  Sebastian Calonico aff007;  Daniel Feaster aff008;  Zinzi Bailey aff009;  Adina Zeki Al Hazzouri aff010
Působiště autorů: Center for Health Equity in Kidney Disease, University of New Mexico School of Medicine, Albuquerque, NM, United States of America aff001;  Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America aff002;  Division of Epidemiology, Department of Public Health Sciences, University of Miami, Miami, FL, United States of America aff003;  Division of Preventative Medicine, Department of Medicine, University of Alabama, Tuscaloosa, AL, United States of America aff004;  Department of Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA, United States of America aff005;  Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America aff006;  Department of Health Policy and Management, Columbia University, New York, NY, United States of America aff007;  Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, FL, United States of America aff008;  Jay Weiss Institute for Health Equity, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States of America aff009;  Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America aff010
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226490



In the United States whites are more likely to misuse opioid pain relievers (OPRs) than blacks, and blacks are less likely to be prescribed OPRs than whites. Our objective is to determine whether racial discrimination in medical settings is protective for blacks against OPR misuse, thus mediating the black-white disparities in OPR misuse.


We used data from 3528 black and white adults in the Coronary Artery Risk Development in Young Adults (CARDIA) study, an ongoing multi-site cohort. We employ causal mediation methods, with race (black vs white) as the exposure, lifetime discrimination in medical settings prior to year 2000 as the mediator, and OPR misuse after 2000 as the outcome.


We found black participants were more likely to report discrimination in a medical setting (20.3% vs 0.9%) and less likely to report OPR misuse (5.8% vs 8.0%, OR = 0.71, 95% CI = 0.55, 0.93, adjusted for covariates). Our mediation models suggest that when everyone is not discriminated against, the disparity is wider with black persons having even lower odds of reporting OPR misuse (OR = 0.63, 95% CI = 0.45, 0.89) compared to their white counterparts, suggesting racial discrimination in medical settings is a risk factor for OPR misuse rather than protective.


These results suggest that racial discrimination in a medical setting is a risk factor for OPR misuse rather than being protective, and thus could not explain the seen black-white disparity in OPR misuse.

Klíčová slova:

Cardiology – Death rates – Epidemiology – Heroin – Medical education – Opioids – Racial discrimination – Social discrimination


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2019 Číslo 12