(1201) Racial Disparities in Analgesia Prescribing Practices in Mechanically Ventilated Patients

Introduction: Racial differences in pain management are well documented in outpatient settings, but the degree to which these differences exist in the intensive care unit (ICU) are underexplored. We examined the relationship between the patient’s race, the ICU provider’s race, and their intersection with intravenous (IV) anxiolytic and analgesia administration in critically ill mechanically ventilated patients. We hypothesized that the race of the nurse and the patient influence analgesic and sedative administration patterns.

Methods: We performed a retrospective analysis of adult Black and White mechanically ventilated patients from 2018 to 2020 in 19 ICUs at 9 hospitals in an integrated health system in the United States. We excluded patients with indications for IV analgesia and anxiolysis other than traditional ICU sedation. Our primary outcomes were sedation administration during each 12-hour nursing shift expressed as oral morphine equivalents, lorazepam equivalents, and propofol (in milligrams). We tested the relationship between patient race, nurse race, and sedation administration using zero-inflated negative binomial regression, adjusting for gender, severity of illness, and other potential confounders.

Results: The final analysis included 7,584 patients and 69,287 patient-shifts. Among patients,15.4% were Black and 84.6% were White; among nurse shifts, 3% were Black and 97% White. In unadjusted analyses, Black patients (compared to White patients) received significantly more morphine equivalents (555 vs 501, p< 0.01) and propofol (1495 vs 1344, p< 0.01) in shifts when the nurse was White. In adjusted analyses, Black patients received more morphine equivalents (incident rate ratio=1.22, 95% CI: 1.02 – 1.45, p=0.03) during shifts when the nurse was White; and received more lorazepam equivalents (incident rate ratio=2.88, 95%CI: 1.11 – 7.50, p=0.03) during shifts when the nurse was Black. No other relationships were statistically significant.

Conclusions: Mechanically ventilated Black patients receive higher doses of some sedatives compared to White patients, which could negatively affect patient outcomes. Better understanding these issues is an important preparatory step towards rectifying racial health disparities in critical care.