ArticleAnnals of surgical oncology2023
Association of Race/Ethnicity, Persistent Poverty, and Opioid Access Among Patients with Gastrointestinal Cancer Near the End of Life.
Article in Annals of surgical oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Ethnic inequalities in palliative care prescribing in high income countries - a rapid systematic review.BMC palliative care · 2025Pooled it
- Impact of Hydrocodone Rescheduling on Pharmaceutical Pain Management in End-of-Life Lung Cancer Patients.Journal of palliative care · 2026Article
- Disparities associated with race and ethnicity in pain management: a scoping review.International journal of clinical pharmacy · 2026Article
- Article
- Cancer Burden in Persistent Poverty Areas across the Cancer Continuum: A Scoping Review to Identify Gaps and Opportunities for Future Research.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2026Article
- Prescription Monitoring Program Mandates and Opioids Dispensed to Patients Dying of Cancer.JCO oncology practice · 2026Article
- Racial and Ethnic Disparities in Pharmacologic and Non-Pharmacologic Pain Management Among Older Cancer Survivors.Cancer medicine · 2026Article
- Trends in Outpatient Opioid Prescriptions for Cancer Pain Between 2016 and 2021.JCO oncology practice · 2025Article
- Post-Acute Transition to Home With Supportive Care (PATHS): A Novel Nurse Practitioner-Led Telehealth Intervention to Improve End-of-Life Oncology Care.Journal of pain and symptom management · 2025Article
- Distribution of pharmacy deserts and its association with digital divide and residential redlining across the United States.PloS one · 2025Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSocial determinants of health (SDoH) can impact access to healthcare. We sought to assess the association between persistent poverty (PP), race/ethnicity, and opioid access among patients with gastrointestinal cancer near the end-of-life (EOL).
methodsSEER-Medicare patients with gastric, liver, pancreatic, biliary, colon, and rectal cancer were identified between 2008 and 2016 near EOL, defined as 30 days before death or hospice enrolment. Data were linked with county-level poverty from the American Community Survey and the US Department of Agriculture (2000-2015). Counties were categorized as never high-poverty (NHP), intermittent high-poverty (IHP) and persistent poverty (PP). Trends in opioid prescription fills and daily dosages (morphine milligram equivalents per day) were examined.
resultsAmong 48,631 Medicare beneficiaries (liver: n = 6551, 13.5%; pancreas: n = 13,559, 27.9%; gastric: n = 5486, 1.3%; colorectal: n = 23,035, 47.4%), there was a steady decrease in opioid prescriptions near EOL. Black, Asian, Hispanic, and other racial groups had markedly decreased odds of filling an opioid prescription near EOL (Black: OR 0.84, 95% CI 0.79-0.90; Asian: OR 0.86, 95% CI 0.79-0.94; Hispanic: OR 0.90, 95% CI 0.84-0.95; Other: OR 0.83, 95% CI 0.74-0.93; all p < 0.05). Even after filling an opioid prescription, this subset of patients received lower daily doses versus White patients (Black: -16.5 percentage points, 95% CI -21.2 to -11.6; Asian: -11.9 percentage points, 95% CI -18.5 to -4.9; Hispanic: -19.1 percentage points, 95%CI -23.5 to -14.6; all p < 0.05). The disparity in opioid access and average daily doses among was attenuated in IHP/PP areas for Asian, Hispanic, and other racial groups, yet exacerbated among Black patients.
conclusionsRace/ethnicity-based disparities in EOL pain management persist with SDoH-based variations in EOL opioid use. In particular, PP impacted EOL opioid access and utilization.
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