Patient Safety and Quality

Studies examine racial/ethnic disparities and use patterns for nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat inflammatory, arthritic, and musculoskeletal conditions. However, they can cause gastrointestinal (GI) and other complications, especially among the elderly. A new study reveals disparities in understanding and care related to NSAIDs among low-income, elderly blacks. A second study finds that individuals taking two NSAIDs have worse daily functioning than those taking just one, and may be self-treating unrelieved pain.

Both studies were supported by the Agency for Healthcare Research and Quality (HS10389). They are briefly discussed here.

Fry, R.B., Ray, M.N., Cobaugh, D.J., and others (2007, December). "Racial/ethnic disparities in patient-reported nonsteroidal anti-inflammatory drug (NSAID) risk awareness, patient-doctor NSAID risk communication, and NSAID risk behavior." Arthritis & Care Research 57(8), pp. 1539-1545.

The research team analyzed survey data from the Alabama NSAID Patient Safety Study on predominantly low-income elderly persons currently taking prescription NSAIDs (one-third of the participants were black). The elderly blacks surveyed were less likely than their white counterparts to recognize any risk associated with over-the-counter (OTC) NSAIDs (13.3 vs. 29.3 percent) and prescribed NSAIDs (31.3 vs. 49.6 percent). They were also less likely to report that their doctor discussed with them possible NSAID-related GI problems (38 vs. 52.4 percent) and to take medications to reduce NSAID-related ulcer risk (30.5 vs. 50.2 percent). These racial/ethnic differences persisted after accounting for other factors. Patients with lower income and education reported significantly less risk awareness for both OTC and prescribed NSAIDs. The study authors call for more efforts to promote safe NSAID use and to reduce ethnic/racial disparities.

Kovac, S.H., Saag, K.G., Curtis, J.R., and Allison, J. (2008, February). "Association of health-related quality of life with dual use of prescription and over-the-counter nonsteroidal anti-inflammatory drugs." Arthritis Care & Research 59(2), pp. 227-233.

Many individuals suffering from musculoskeletal conditions such as arthritis may take two prescription NSAIDs or one prescription and one OTC NSAID to reduce the pain and inflammation of their condition. However, use of two NSAIDs boosts their risk of NSAID-related complications such as stomach ulcers and bleeding. This study suggests that many of these individuals take two NSAIDs to self-manage their pain so that they can improve their daily functioning. It found, for example, that individuals taking two NSAIDs, whether they were both prescription NSAIDs or one was an OTC NSAID, had worse health-related quality of life (HRQOL) than those who took only one NSAID.

The study also found that physicians were often not aware that their patients were taking two NSAIDs. This could have two effects. The patients' pain may not be adequately managed by the physician, and the physician may not be aware of and cannot convey the risks of using two NSAIDs to these patients, explain the researchers. They interviewed patients from a managed care organization who filled one or more NSAID prescriptions over a 6-month period. They then compared the association between dual use NSAIDs and the Physical Component Summary score (PCS-12) from the Short Form 12 (SF-12) Health Survey. About half of the patients had rheumatoid arthritis or osteoarthritis and about one-fourth had chronic back pain. Overall, 26 percent of those interviewed reported use of two NSAIDs. Dual use independently predicted worse physical function scores on the PCS-12 after controlling for several patient and disease characteristics. These patients may have been seeking relief from inadequate pain management, suggest the researchers. Other significant factors associated with lower PCS-12 scores were being unemployed and having more coexisting medical conditions.

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