Cancer Pain in Relation to Metropolitan Area Segregation and Nursing Home Racial and Ethnic Composition.
Bill M Jesdale, Deborah S Mack, Sarah N Forrester and 1 others
PMID 32224259WHAT IT FOUND
Pain documentation was lower among nursing home residents with cancer in more segregated metropolitan areas and in mostly Black or mostly Hispanic homes.
This pattern appeared for Black, Hispanic, and White residents, not only minority residents.
Key findings
01In unadjusted analyses, pain reporting decreased as metropolitan area segregation increased for Black, Hispanic, and White residents.
02In extremely segregated areas, Black residents were 4.6% less likely, Hispanic residents 6.9% less likely, and White residents 7.4% less likely to report pain than in least segregated areas.
03Within similar segregation levels, Black residents in mostly Black homes and Hispanic residents in mostly Hispanic homes were less likely to report pain than in predominantly White homes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study measured documented pain in records, not pain experience, so lower documentation may mean under-recognition rather than less pain. It was observational and cannot show that segregation caused lower pain documentation. The analysis used admission records, so findings may not apply to long-stay residents. Residents who could not make themselves understood were excluded, which may hide under-reported pain linked to communication difficulty. The study could not test the proposed mechanisms, such as provider bias, resident trust, or unequal resources. Segregation was measured using 2010 Census data. The analysis was limited to Hispanic, non-Hispanic Black, and non-Hispanic White residents and to nursing homes with at least 10 residents of known race/ethnicity.
Declared interests
No conflict-of-interest statement is included in the supplied text. The article is supported by NIH extramural research funding.
The easy way to misread this
Do not read lower documented pain as evidence that residents have less pain. The study measured pain documentation in nursing home records, not the pain experienced, and lower reporting may reflect under-ascertainment or structural inequities.