(1021) Disparities in Pain Management Among Transgender Patients Presenting to the ED for Abdominal Pain

Introduction: 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 healthcare inequities. Our objective was to identify if there are treatment differences between TGD and cisgender lesbian/gay/bi-sexual/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 healthcare system with a chief complaint of abdominal pain between 2018-2022. 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 minutes 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 age was 25 (IQR 20-32) and most patients were treated in a community ED (58.2%). There was no difference between groups in pain assessment within 60 minutes 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 2 [IQR 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 NSAIDs (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). 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).

Conclusions: 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.