Ethnic disparities in opioid prescribing for cancer pain and associated emergency department visits and hospital admissions in the last three months of life: a retrospective cohort study

Background

Ethnic inequalities in pain management at the end of life remain underexplored in the UK. We examined associations between patient ethnicity, opioid prescribing, and related healthcare use among cancer decedents.

Methods

Retrospective cohort study including 232,329 adults (≥18 years) diagnosed with cancer between 2011 and 2021. Primary care records from the Clinical Practice Research Datalink Aurum were linked to hospital and mortality data. Person-time rates of opioid prescriptions, emergency department (ED) visits, and hospital admissions in the last three months of life were estimated. Poisson regression with Generalised Estimating Equations generated adjusted rate ratios (aRRs) and 95% confidence intervals (CIs), controlling for relevant covariates.

Results

Of 3,987,635 opioid prescriptions, 620,232 (16%) occurred in the final three months. Prescription rates were highest among White patients (969.97–894.43/1000 person-months). Compared with White patients, prescribing was significantly lower among Black (aRR 0.91, 95% CI 0.87–0.95), South Asian (aRR0.93, CI0.89–0.97), Mixed (aRR 0.85, CI 0.79–0.92) and Other ethnic groups (aRR 0.90, CI 0.85–0.96). Patients from minority ethnic backgrounds, particularly Black and South Asian, more often experienced ≥2 ED visits and ≥2 hospital admissions.

Conclusion

Minority ethnic patients with cancer receive fewer opioids and experience higher acute care use near the end of life. Tackling system-level inequities is critical to achieving pain management.