Socioeconomic and racial disparities found in pediatric opioid prescriptions
A study presented at the 2024 AAP Conference found that white children and those from higher socioeconomic backgrounds are more likely to receive opioid prescriptions for fractures. Despite effective non-opioid alternatives, disparities persist in opioid prescription patterns.
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Children from wealthier backgrounds and white patients are significantly more likely to be prescribed opioids for common fractures, according to new research presented at the American Academy of Pediatrics 2024 National Conference & Exhibition. The findings, drawn from the Pediatric Health Information System (PHIS) and spanning 52 pediatric hospitals, point to concerning disparities in opioid prescription patterns.
The study, titled “Overprescription of Opioids in White Children from Higher Socioeconomic Backgrounds: Disparities in Opioid Utilization for Pediatric Supracondylar Humerus Fractures,” analyzed 35,452 pediatric patients between 2012 and 2021 who were treated for non-operative supracondylar humerus fractures—commonly referred to as broken elbows. Of these children, approximately 30.3% (10,731) received at least 1 opioid dose during their visit.
Nonmedical opioid use among children and adolescents has long been recognized as a public health concern, with many adolescents transitioning to opioid misuse following an initial prescription. This study sought to determine how factors such as race, socioeconomic status, and other demographics affected the likelihood of receiving opioid prescriptions.
Apurva Shah, MD, MBA, an attending surgeon in Orthopaedic Surgery at the Children’s Hospital of Philadelphia (CHOP), who authored the study, noted significant trends related to race and socioeconomic background. The data revealed that white patients were 10% more likely to receive opioid prescriptions compared to other racial groups (OR 1.1, p=0.016), while Black children were 27% less likely to be prescribed opioids.
Additional findings highlighted the influence of the Childhood Opportunity Index (COI), a measure of socioeconomic opportunity in a child’s environment. Children from moderate to very high COI areas were significantly more likely to receive opioid prescriptions (OR 1.1–1.2) compared to those from very low COI regions, further indicating that children with greater access to healthcare are at an increased risk of being overprescribed opioids.
"Non-opioid pain management has proven sufficient for pain management," Shah explained. "As orthopaedic surgeons, we clearly need improved opioid use stewardship to improve healthcare outcomes for our patients."
The study also found that age played a role in prescription disparities, with older children (aged 5-13 years) being 40% more likely to receive opioids than younger children (aged 1-5 years) (OR 1.4, p<0.001). Children covered by public insurance were less likely to be prescribed opioids (OR 0.85, p=0.001), further highlighting economic disparities in healthcare access and treatment.
Despite evidence supporting the efficacy of non-opioid alternatives such as acetaminophen or ibuprofen for treating supracondylar humerus fractures, the continued high rate of opioid prescriptions—especially among white children and those from higher socioeconomic backgrounds—raises concerns about the long-term impact on public health. For many adolescents, an initial opioid prescription can serve as a gateway to potential misuse later in life.
This research, funded by CHOP’s Division of Orthopaedics, underscores the need for more equitable and responsible opioid prescription practices, particularly in pediatric care. Shah emphasized that pediatricians must consider the potential harm of overprescribing opioids, particularly to populations with easier access to health care.
