因腹痛前往急诊科就诊的跨性别患者在疼痛管理方面存在差异。

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

作者信息

Engstrom Kellyn, Bellolio Fernanda, Jeffery Molly Moore, Sutherland Sara C, Carpenter Kayla P, Jackson Gia, Cole Kristin, Chedid Victor, Davidge-Pitts Caroline J, Sunga Kharmene L, Gonzalez Cesar, Brown Caitlin S

机构信息

Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.

Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Acad Emerg Med. 2025 Feb;32(2):130-136. doi: 10.1111/acem.15027. Epub 2024 Oct 3.

DOI:10.1111/acem.15027

PMID:39363515

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.

摘要

目的

跨性别者和性别多样化（TGD）个体的性别认同或表达方式与他们出生时被指定的性别不同。他们是未得到充分医疗服务的人群，面临医疗保健不平等问题。我们的主要目的是确定在急诊科（ED）因腹痛就诊的TGD个体与顺性别女同性恋/男同性恋/双性恋/酷儿（LGBQ）或异性恋个体之间是否存在治疗差异。

方法

对2018年至2022年期间在一个医疗系统内21家急诊科就诊、主诉为腹痛的12岁及以上患者进行回顾性观察队列研究。TGD患者分别与顺性别LGBQ女性和男性以及顺性别异性恋女性和男性按1:1:1:1进行匹配。倾向得分匹配协变量包括年龄、急诊科地点、心理健康史和胃肠道病史。主要结局是到达后60分钟内的疼痛评估。次要结局是在急诊科给予的镇痛药。

结果

我们确定了300例TGD患者，其中300例TGD患者成功匹配，总队列共1300例患者。中位（IQR）年龄为25（20 - 32）岁，大多数患者在社区急诊科接受治疗（58.2%）。到达后60分钟内的疼痛评估在各组之间没有差异（TGD组为59.0%，非TGD组为63.2%，p = 0.19）。疼痛评估次数（中位[IQR] 2 [1 - 3] 对 2 [1 - 4]，p = 0.31）或组间疼痛严重程度（5.5 [4 - 7] 对 6 [4 - 7]，p = 0.11）没有差异。与非TGD患者相比，TGD患者更有可能接受非甾体类抗炎药（32.0% 对 24.9%，p = 0.015），而接受阿片类药物的可能性较小（24.7% 对 36.9%，p < 0.001）。TGD和非二元性别患者，以及LGBQ顺性别女性（24.7%）和异性恋顺性别女性（34%），与LGBQ顺性别男性（54%）和异性恋顺性别男性（42.3%）相比，接受阿片类药物的可能性较小（p < 0.01）。