O3266: Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures

Background: Nonmedical use of opioids in children and adolescents is a well-established public health concern. For many adolescent patients, an initial opioid prescription can act as a gateway that may lead to opioid misuse later in life. The purpose of this study is to investigate if patient factors, including sex, race, ethnicity, or Childhood Opportunity Index (COI), are associated with higher or lower likelihood of opioid prescription in children with fractures, utilizing pediatric supracondylar humerus fracture as an archetypal example.

Methods: Data was obtained from the Pediatric Health Information System (PHIS), an administrative database consisting of patient encounters across 52 pediatric hospitals. Patients with supracondylar humerus fractures who presented to an emergency department and were treated non-operatively were included. The primary outcome variable of interest was whether or not patients received an opioid prescription. We also extracted and assessed patient-level predictors for opioid use, including age, sex, race, ethnicity, primary payer, COI, and geographic region. To account for hospital level variation, we conducted mixed-effects logistic regression.

Results: In total, 35,452 children (52% male) with non-operative supracondylar humerus fractures at a mean age of 5.7 ± 2.8 years were included. About one-third of patients (10,731; 30.3%) received at least one dose of opioids. After accounting for hospital-level characteristics, White patients were significantly more likely to receive an opioid prescription (OR 1.1, p=0.016), while those with public insurance were less likely (OR 0.85, p=0.001). Kids from moderate, high, and very high COI regions were significantly more likely to receive opioids compared to very low COI regions (OR 1.1-1.2). Additionally, older children (5-13 years) were significantly more likely to be prescribed more opioids compared to younger children (1-5 years) (OR 1.4, p< 0.001). No differences due to region or sex were found statistically significant. Results are further described in Table 1.

Conclusion: Opioids for supracondylar humerus fractures, despite the efficacy of non-opioid alternatives, are prescribed at high rates and disproportionately to White children and patients from higher COI areas, reflecting important socioeconomic disparities in opioid prescription patterns. Though non-opioid pain management using acetaminophen or ibuprofen provides sufficient pain control for treating supracondylar humerus fractures, unfortunately, almost one-third of patients being treated non-operatively were prescribed opioids. Our investigation demonstrates that White patients and children with higher COI are especially likely to be prescribed opioids, indicating that prescription pattern disparities may be harming the portion of the population that has historically had better access to healthcare.