Are opioid use disorder assessments in the emergency department biased? An examination across sex, race, and employment status using item response theory

Background: In acute care settings such as the emergency department (ED), the absence of test bias is essential for any assessment. Unbiased assessments of the DSM-5 criteria for opioid use disorder (OUD) are crucial to ensure valid comparison of OUD severity, though focused tests of potential bias are lacking.

Method: This study used item response theory (IRT) to examine potential test bias across patient characteristics (i.e., sex, race, employment status) in a sample of 518 individuals aged 18+ who reported opioid use within the prior 12 months. Participants indicated the presence or absence of the 11 DSM-5 OUD criteria, as well as self-reported demographic information.

Results: IRT indicated a lack of test bias (i.e., measurement invariance) for DSM-5 OUD across biological sex, race, and employment status. The lack of test bias permitted the groups to be compared on OUD severity across demographic groups. Males, White individuals, and unemployed individuals reported higher OUD severity.

Conclusions: Findings indicate the DSM-5 OUD criteria are unbiased across sex, race, and employment status. Thus, these criteria can be used in the ED to compare differences in OUD severity across key demographic groups. The current study provides empirical support for using OUD assessments in ED settings to inform in-vivo clinical decisions across different sexes, races, and employment statuses. Future studies are needed to corroborate this finding in additional samples and across additional demographic characteristics (e.g., ethnicity, age).