Pain Care Disparities and the Use of Virtual Care Among Racial-Ethnic Minority Groups During COVID-19.

Pain Care Disparities and the Use of Virtual Care Among Racial-Ethnic Minority Groups During COVID-19.

Publication date: Jan 22, 2024

COVID-19 led to an unprecedented reliance on virtual modalities to maintain care continuity for patients living with chronic pain. We examined whether there were disparities in virtual specialty pain care for racial-ethnic minority groups during COVID-19. This was a retrospective national cohort study with two comparison groups: primary care patients with chronic pain seen immediately prior to COVID-19 (3/1/19-2/29/20) (N = 1,649,053) and a cohort of patients seen in the year prior (3/1/18-2/28-19; n = 1,536,954). We assessed use of telehealth (telephone or video) specialty pain care, in-person care specialty pain care, and any specialty pain care for both groups at 6 months following cohort inclusion. We used quasi-Poisson regressions to test associations between patient race and ethnicity and receipt of care. Prior to COVID-19, there were Black-White (RR = 0. 64, 95% CI [0. 62, 0. 67]) and Asian-White (RR = 0. 63, 95% CI [0. 54, 0. 75]) disparities in telehealth use, and these lessened during COVID-19 (Black-White: RR = 0. 75, 95% CI [0. 73, 0. 77], Asian-White: RR = 0. 81, 95% CI [0. 74, 0. 89]) but did not disappear. Individuals identifying as American Indian/Alaska Native used telehealth less than White individuals during early COVID-19 (RR = 0. 98, 95% CI [0. 85, 1. 13] to RR = 0. 87, 95% CI [0. 79, 0. 96]). Hispanic/Latinx individuals were less likely than non-Hispanic/Latinx individuals to use telehealth prior to COVID-19 but more likely during early COVID-19 (RR = 0. 70, 95% CI [0. 66, 0. 75] to RR = 1. 06, 95% CI [1. 02, 1. 09]). Disparities in virtual pain care occurred over the backdrop of overall decreased specialty pain care during the early phase of the pandemic (raw decrease of n = 17,481 specialty care encounters overall from pre-COVID to COVID-era), including increased disparities in any VA specialty pain care for Black (RR = 0. 81, 95% CI [0. 80, 0. 83] to RR = 0. 79, 95% CI [0. 77, 0. 80]) and Asian (RR = 0. 91, 95% CI [0. 86, 0. 97] to RR = 0. 88, 95% CI [0. 82, 0. 94]) individuals. Disparities in virtual specialty pain care were smaller during the early phases of the COVID-19 pandemic than prior to the pandemic but did not disappear entirely, despite the rapid growth in telehealth. Targeted efforts to increase access to specialty pain care need to be concentrated among racial-ethnic minority groups.

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Concepts Keywords
Alaska COVID-19
Covid disparity
Hispanic pain
Pandemic telehealth
virtual care.


Type Source Name
disease MESH COVID-19
disease MESH chronic pain
disease VO USA
disease VO population
disease MESH complications
disease MESH suicide
disease MESH premature death
disease VO ineffective
disease IDO quality
drug DRUGBANK Serine
disease MESH emergency
drug DRUGBANK Methionine
disease MESH back pain
disease MESH joint pain
disease MESH fibromyalgia
disease MESH menstrual pain
disease MESH chest pain
drug DRUGBANK Diethylstilbestrol
disease MESH complex regional pain syndrome
disease MESH systemic lupus erythematosus
pathway KEGG Systemic lupus erythematosus
disease MESH deformities
disease VO age
disease MESH Marital status
disease MESH temporomandibular disorder
drug DRUGBANK Coenzyme M
disease VO report
drug DRUGBANK Ethionamide
disease MESH panic
pathway REACTOME Reproduction
drug DRUGBANK Guanosine
disease MESH headache disorders
disease MESH opioid addiction
disease MESH Arthritis
disease MESH low back pain
drug DRUGBANK Amlodipine
drug DRUGBANK L-Aspartic Acid
disease MESH musculoskeletal pain
drug DRUGBANK Indoleacetic acid

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