Social Determinants of Health: Modeling and Targeting Patient Propensity to Attend Pain Clinic Appointments

Abstract

Aim: We sought to investigate the impact of social determinants of health on pain clinic attendance. Materials & methods: Retrospective data were collected from the Pain Center at Montefiore Medical Center from 2016 to 2020 and analyzed with multivariable logistic regression. Results: African–Americans were less likely to attend appointments compared with White patients (odds ratio [OR]: 0.73; 95% CI: 0.70–0.77; p < 0.001). Males had decreased attendance compared with females (OR: 0.89; 95% CI: 0.87–0.92; p < 0.001). Compared with commercial, those with Medicaid (OR: 0.69; 95% CI: 0.66–0.72; p < 0.001) and Medicare (OR: 0.76; 95% CI: 0.73–0.80; p < 0.001) insurance had decreased attendance. Conclusion: Significant disparities exist in pain clinic attendance based upon social determinants of health including race, gender and insurance type.

Plain language summary

We aimed to investigate social determinants of health, such as race and type of insurance, and their role in patients’ attendance of pain clinic appointments. Data were collected over several years and statistical analysis was performed on over 145,000 patient encounters. It was found that patients with Medicaid and Medicare were less likely to attend appointments compared with patients with commercial insurance. Black or African–American patients were also less likely to attend compared with White patients. Spanish speaking patients were more likely to attend compared with English speaking patients, showing that previous interventions aimed at reducing the language barrier for Spanish speaking patients continue to be successful after many years. Overall, significant disparities exist in pain clinic attendance based upon social determinants of health. Further research is needed to investigate reasons and potential areas of interventions. Patients insured with Medicare and Medicaid may also have greater transportation issues, a potential focus for further studies and targeted interventions

Tweetable abstract

Significant disparities exist in pain clinic attendance based upon social determinants of health, including race and insurance status. #SocialDeterminantsofHealth #HealthcareDisparaties

Keywords::

• access to care
• adherence
• chronic pain
• clinic appointments
• healthcare disparities
• social determinants of health

Financial & competing interests disclosure

R White is the recipient of a FAER Mentored Research Training Grant (ID: MRTG-08-15-2021-White [Robert]). L Witkin has funding from the Applebaum Foundation. N Shaparin has funding from Heron Therapeutics, Averitas Pharma and AcelRx Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations.

Additional information

Funding

R White is the recipient of a FAER Mentored Research Training Grant (ID: MRTG-08-15-2021-White [Robert]). L Witkin has funding from the Applebaum Foundation. N Shaparin has funding from Heron Therapeutics, Averitas Pharma and AcelRx Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.