{"pk":17163,"title":"Disparate Utilization of Urine Drug Screen Nationwide in the Evaluation of Acute Chest Pain","subtitle":null,"abstract":"Introduction: Urine drug screens (UDS) have unproven clinical utility in emergency department (ED) chest pain presentations. A test with such limited clinical utility may exponentiate biases in care, but little is known about the epidemiology of UDS use for this indication. We hypothesized that UDS utilization varies nationally across race and gender.\nMethods: This was a retrospective observational analysis of adult ED visits for chest pain in the 2011–2019 National Hospital Ambulatory Medical Care Survey. We calculated the utilization of UDS across race/ethnicity and gender and then characterized predictors of use via adjusted logistic regression models.\nResults: We analyzed 13,567 adult chest pain visits, representative of 85.8 million visits nationally. Use of UDS occurred for 4.6% of visits (95% CI 3.9%-5.4%). White females underwent UDS at 3.3% of visits (95% CI 2.5%-4.2%), and Black females at 4.1% (95% CI 2.9%-5.2%). White males were tested at 5.8% of visits (95% CI 4.4%-7.2%), while Black males were tested at 9.3% of visits (95% CI 6.4%-12.2%). A multivariate logistic regression model including race, gender, and time period shows significantly increased odds of ordering UDS for Black patients (odds ratio [OR] 1.45 (95% CI 1.11-1.90, p = 0.007)) and male patients (OR 2.0 (95% CI 1.55-2.58, p < 0.001) as compared to White patients and female patients.\nConclusion: We identified wide disparities in the utilization of UDS for the evaluation of chest pain. If UDS were used at the rate observed for White women, Black men would undergo nearly 50,000 fewer tests annually. Future research should weigh the potential of the UDS to magnify biases in care against the unproven clinical utility of the test.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"toxicology"},{"word":"Urine Drug Screening"},{"word":"chest pain"},{"word":"racial disparities"}],"section":"Health Equity","is_remote":true,"remote_url":"https://escholarship.org/uc/item/29z8t886","frozenauthors":[{"first_name":"Daniel","middle_name":"L.","last_name":"Overbeek","name_suffix":"","institution":"University of Rochester School of Medicine and Dentistry, Department of Emergency\nMedicine, Rochester, New York","department":"None"},{"first_name":"Alexander","middle_name":"T.","last_name":"Janke","name_suffix":"","institution":"Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut; Institute for Healthcare Policy and Innovation, VA Ann Arbor/University of Michigan, Ann Arbor, Michigan","department":"None"},{"first_name":"C.","middle_name":"James","last_name":"Watson","name_suffix":"","institution":"Boston Children’s Hospital, Harvard Medical Toxicology Program, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts","department":"None"},{"first_name":"Rama","middle_name":"A.","last_name":"Salhi","name_suffix":"","institution":"Massachusetts General Hospital, Department of Emergency Medicine, Boston,\nMassachusetts","department":"None"},{"first_name":"Erin","middle_name":"","last_name":"Kim","name_suffix":"","institution":"University of Michigan Medical School, Ann Arbor, Michigan","department":"None"},{"first_name":"Dowin","middle_name":"","last_name":"Boatright","name_suffix":"","institution":"New York University Grossman School of Medicine, Department of Emergency Medicine, New York, New York","department":"None"},{"first_name":"Eve","middle_name":"D.","last_name":"Losman","name_suffix":"","institution":"University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan","department":"None"}],"date_submitted":"2022-08-01T20:07:23Z","date_accepted":"2022-08-01T20:07:23Z","date_published":"2023-03-06T08:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17163/galley/8671/download/"}]}