Racial and ethnic differences in opioid fills following cancer-directed surgery among older and younger Medicare beneficiaries

Abstract BACKGROUND Opioid receipt differs by race and ethnicity across multiple settings, yet few studies have examined disparities after cancer-directed surgery. METHODS Using fee-for-service Medicare claims, we identified cancer-directed surgeries between 2012 to 2021. Multivariable linear regression models estimated racial and ethnic differences in postoperative opioid fills and doses within 30-days, adjusting for demographic and clinical factors. We ran separate models among older (age ≥ 65) and younger (age 65) Medicare beneficiaries (who typically qualify based on disability), and further models by preoperative opioid use (opioid-naïve vs not). RESULTS We identified 958,593 surgical episodes. Overall 84.9% were non-Hispanic White (White), 8.1% non-Hispanic Black (Black), 4.4% Hispanic, and 2.2% Asian. Among older beneficiaries, Black and Hispanic patients were 4.7 95%CI : 4.3,5.1 and 3.1 95%CI : 2.6,3.6 percentage points more likely to fill ≥1 opioid than White patients. Mean 30day doses were similar between Black and White patients; whereas Hispanic and Asian patients filled modestly lower doses (-22 MME 95%CI:-27,-16, -53 MME 95%CI:-61,-46). Among younger beneficiaries, opioid fill rates were relatively similar across racial and ethnic groups. However, mean 30-day doses were substantially lower among Black (-135 MME 95%CI:-154,-115), Hispanic (-167 MME 95%CI:-198,-136), and Asian (-259 MME 95%CI:-327,-191) vs White patients, particularly those with prior opioid use. CONCLUSIONS We observed modest racial and ethnic differences in opioid fills following cancer-directed surgeries among older Medicare beneficiaries. However, among younger beneficiaries, Black, Hispanic, and Asian patients filled substantially lower 30-day doses than White patients, primarily among those with prior opioid use. Cancer pain equity efforts should target populations experiencing meaningful disparities.