Relating Racial Disparities to Financial Concerns and Shared Decision Making in Opioid Prescriptions

Abstract

In this thesis, the author uses clinical notes and works with three widely-accessible healthcare databases to examine the relationship between race and opioid prescriptions in hospitals. While other researchers have previously provided evidence that Black patients receive, ceteris paribus, fewer opioid prescriptions than White patients in American hospitals, this work adds three components of analysis. First, this work adds opioid analysis for Asian and Hispanic patients, which has not been previously attempted. Second, the author creates two derived metrics from clinical notes that serve as proxies for financial hardship in covering medical costs, and willingness to participate in shared decision making. These metrics are then shown to strongly correlate with probability of opioid prescription - greater financial hardship implies fewer opioid prescriptions, and greater participation implies more opioid prescriptions. Finally, this work shows that despite the classification power of the derived metrics, those factors do not account for the racial disparity between Black patients and other races with respect to opioid prescriptions. That is, even when controlling for financial hardship and likeliness to complain, Black patients are still shown to have statistically fewer chances of receiving opioid prescriptions than all other racial groups.