R. Y. Shields1, N. Nagarajan1, B. Lau1, C. Zogg1, L. Kodadek1, A. Robinson2, D. German2, A. Ranjit1, S. Peterson1, A. Haider1 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA 2Johns Hopkins Bloomberg School Of Public Health,Baltimore, MD, USA
Introduction:
Widespread health and healthcare disparities for lesbian, gay, and bisexual (LGB) patients have been well documented in a variety of ambulatory settings. However, no information of specific treatments, outcomes, or risks in the emergency department (ED) or surgical settings exists for this population. Using the ED as a point of entry, we aimed to estimate the number of LGB patients who seek emergent surgical care annually by extrapolating from existing population data.
Methods:
A review was done to find studies that surveyed sexual orientation. We searched MEDLINE/PubMed, Embase, CINAHL, and Scopus using controlled vocabulary and relevant free text which included: LGB*, homosexual*, health care. We included studies that reported proportion of LGB individuals, conducted within the United States, and published between 1980-2013. Studies that reported sexual behavior or attraction, did not use standardized question formats, or had high rates of missing data were not included. We extracted relevant data from these studies to determine estimated LGB proportions in the general population. Using national estimates of ED visits from the HCUP National Emergency Department Sample (NEDS) and ICD-9 codes to identify patients needing surgical consultations, we calculated a nationally-representative number (and corresponding 95% CI) of LGB individuals seeking surgical care in the ED.
Results:
We reviewed 405 potentially relevant papers, of which 3 satisfied our inclusion criteria (Table). Combining their results, we estimated that 2.78% (95% CI: 2.73-2.84) of the U.S. population identify as LGB. Data from the 2011 NEDS estimated a total of 131,048,605 ED visits. Of the 131 million ED visits, 14 million required emergent surgical care. Assuming that 2.78% of the ED visits were by self-identifying LGB individuals, there were approximately 3.64 million (95% CI: 3.57 – 3.72 million) encounters with LGB patients in the ED in 2011. Of these, 389,200 (95% CI: 382,200 – 397,600) required a surgical consult.
Conclusion:
Every year, millions of patients who self-identify as LGB seek care in EDs across the country, a significant proportion of whom require surgical care. It is likely that this is a conservative estimate given widespread underreporting of LGB status. It is impossible to further examine potential disparities facing LGB patients seeking surgical care without routine collection of sexual orientation information, a priority for the Institute of Medicine and The Joint Commission. Additional research is needed to develop effective education and training for surgeons and surgical residents to address LGB patients.
