Racial/ethnic differences in staff-assessed pain behaviors among newly-admitted nursing home residents

Abstract Context Nonverbal pain behaviors are effective indicators of pain among persons who have difficulty communicating. In nursing homes, racial/ethnic differences in self-reported pain and pain management have been documented. Few studies have examined racial/ethnic differences in nonverbal pain behaviors and pain management among residents with staff-assessed pain. Methods We used the US national Minimum Data Set 3.0, and identified 994,510 newly-admitted nursing home residents for whom staff evaluated pain behaviors and pain treatments between 2010-2016. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) estimated using robust Poisson models compared pain behaviors and treatments across racial/ethnic groups. Results Vocal complaints were most commonly recorded (18.3% non-Hispanic Black residents, 19.3% of Hispanic residents, 30.3% of non-Hispanic White residents). Documentation of pain behaviors was less frequent among non-Hispanic Black and Hispanic residents than non-Hispanic White residents (e.g., vocal complaints: aPR Black: 0.76; 95% CI: 0.73 - 0.78; with similar estimates for other pain behaviors). Non-Hispanic Blacks (47.3%) and Hispanics (48.6%) were less likely to receive any type of pharmacologic pain intervention compared to non-Hispanic White residents (59.3%) (aPR Black: 0.87, 95% CI: 0.86-0.88; aPR Hispanics: 0.87, 95% CI: 0.84-0.89). Conclusions Among residents requiring staff assessment of pain because they are unable to self-report, nursing home staff documented pain and its treatment less often in Non-Hispanic Blacks and Hispanics than in non-Hispanic White residents. Studies to understand the role of differences in expression of pain, explicit bias, and implicit bias are needed to inform interventions to reduce disparities in pain documentation and treatment.