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Kirsha S Gordon,1,2 Eugenia Buta,3 Mandi L Pratt-Chapman,4 Cynthia A Brandt,1,3,5 Ralitza Gueorguieva,3 Allison R Warren,6,7 T Elizabeth Workman,8,9 Qing Zeng-Treitler,8,9 Joseph L Goulet1,5 1Research, VA Connecticut Healthcare System, West Haven, CT, USA; 2General Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 3Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA; 4Department of Medicine and The George Washington Cancer Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA; 5Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA; 6Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; 7Pain Research, Informatics, Multi-Morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA; 8Biomedical Informatics Center, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA; 9Research, Washington VA Medical Center, Washington, DC, USACorrespondence: Kirsha S Gordon, VA Connecticut Healthcare System, Bldg. 35A, 950 Campbell Avenue, West Haven, CT, 06516, USA, Tel +1 203-932-5711, Email kirsha.gordon2@va.govBackground: Pain assessment is performed in many healthcare systems, such as the Veterans Health Administration, but prior studies have not assessed whether pain screening varies in sexual and gender minority populations that include individuals who identify as lesbian, gay, bisexual, and/or transgender (LGBT).Objective: The purpose of this study was to evaluate pain screening and reported pain of LGBT Veterans compared to non-LGBT Veterans.Methods: Using a retrospective cross-sectional cohort, data from the Corporate Data Warehouse, a national repository with clinical/administrative data, were analyzed. Veterans were classified as LGBT using natural language processing. We used a robust Poisson model to examine the association between LGBT status and binary outcomes of pain screening, any pain, and persistent pain within one year of entry in the cohort. All models were adjusted for demographics, mental health, substance use, musculoskeletal disorder(s), and number of clinic visits.Results: There were 1,149,486 Veterans (218,154 (19%) classified as LGBT) in our study. Among LGBT Veterans, 94% were screened for pain compared to 89% among those not classified as LGBT (non-LGBT) Veterans. In adjusted models, LGBT Veterans’ probability of being screened for pain compared to non-LGBT Veterans was 2.5% higher (95% CI 2.3%, 2.6%); risk of any pain was 2.1% lower (95% CI 1.6%, 2.6%); and there was no significant difference between LGBT and non-LGBT Veterans in persistent pain (RR = 1.00, 95% CI (0.99, 1.01), p = 0.88).Conclusions: In a nationwide sample, LGBT Veterans were more likely to be screened for pain but had lower self-reported pain scores, though adjusted differences were small. It was notable that transgender and Black Veterans reported the greatest pain. Reasons for these findings require further investigation.Keywords: LGBT, pain, screening, persistent pain, Veterans |
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