Disparities in pain management among transgender patients presenting to the emergency department for abdominal pain.

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE
Kellyn Engstrom, Fernanda Bellolio, Molly Moore Jeffery, Sara C Sutherland, Kayla P Carpenter, Gia Jackson, Kristin Cole, Victor Chedid, Caroline J Davidge-Pitts, Kharmene L Sunga, Cesar Gonzalez, Caitlin S Brown
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Abstract

Objective: Transgender and gender-diverse (TGD) individuals have a gender identity or expression that differs from the sex assigned to them at birth. They are an underserved population who experience health care inequities. Our primary objective was to identify if there are treatment differences between TGD and cisgender lesbian/gay/bisexual/queer (LGBQ) or heterosexual individuals presenting with abdominal pain to the emergency department (ED).

Methods: Retrospective observational cohort study of patients ≥12 years of age presenting to 21 EDs within a health care system with a chief complaint of abdominal pain between 2018 and 2022. TGD patients were matched 1:1:1:1 to cisgender LGBQ women and men and cisgender heterosexual women and men, respectively. Propensity score matching covariates included age, ED site, mental health history, and gastrointestinal history. The primary outcome was pain assessment within 60 min of arrival. The secondary outcome was analgesics administered in the ED.

Results: We identified 300 TGD patients, of whom 300 TGD patients were successfully matched for a total cohort of 1300 patients. The median (IQR) age was 25 (20-32) years and most patients were treated in a community ED (58.2%). There was no difference between groups in pain assessment within 60 min of arrival (59.0% TGD vs. 63.2% non TGD, p = 0.19). There were no differences in the number of times pain was assessed (median [IQR] 2 [1-3] vs. 2 [1-4], p = 0.31) or the severity of pain between groups (5.5 [4-7] vs. 6 [4-7], p = 0.11). TGD patients were more likely to receive nonsteroidal anti-inflammatory drugs (32.0% vs. 24.9%, p = 0.015) and less likely to receive opioids than non-TGD patients (24.7% vs. 36.9%, p = <0.001). TGD and nonbinary patients, along with LGBQ cisgender women (24.7%) and heterosexual cisgender women (34%), were less likely to receive opioids than LGBQ cisgender men (54%) and heterosexual cisgender men (42.3%, p < 0.01).

Conclusion: There was no difference in frequency of pain assessment, regardless of gender identity or sexual orientation. More cisgender men, compared to TGD and cisgender women, received opioids for their pain.

因腹痛到急诊科就诊的变性患者在疼痛处理方面的差异。
目的:变性者和性别多元化者(TGD)的性别认同或性别表达方式与出生时的性别不同。他们是未得到充分服务的人群,在医疗保健方面遭受着不公平待遇。我们的主要目的是确定在急诊科(ED)就诊的腹痛患者中,TGD 与顺性别女同性恋/男同性恋/双性恋/同性恋(LGBQ)或异性恋之间是否存在治疗差异:回顾性观察队列研究,对象为2018年至2022年期间以腹痛为主诉到医疗系统内21家急诊科就诊的年龄≥12岁的患者。TGD患者分别与同性别的LGBQ女性和男性以及同性别的异性恋女性和男性进行了1:1:1:1匹配。倾向得分匹配协变量包括年龄、ED部位、精神健康史和胃肠道病史。主要结果是抵达后 60 分钟内的疼痛评估。次要结果是在急诊室使用的镇痛药:我们确定了 300 名 TGD 患者,其中 300 名 TGD 患者已成功配对,患者总数为 1300 人。中位(IQR)年龄为 25(20-32)岁,大多数患者在社区急诊室接受治疗(58.2%)。两组患者在到达急诊室后 60 分钟内的疼痛评估结果无差异(59.0% 的 TGD 患者对 63.2% 的非 TGD 患者,P = 0.19)。组间疼痛评估次数(中位数[IQR] 2 [1-3] vs. 2 [1-4],p = 0.31)或疼痛严重程度(5.5 [4-7] vs. 6 [4-7],p = 0.11)无差异。与非 TGD 患者相比,TGD 患者更有可能接受非甾体抗炎药治疗(32.0% vs. 24.9%,p = 0.015),而接受阿片类药物治疗的可能性较低(24.7% vs. 36.9%,p = 0.015):无论性别认同或性取向如何,疼痛评估的频率没有差异。与 TGD 和同性别女性相比,更多的同性别男性因疼痛而接受阿片类药物治疗。
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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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