S1210 Premature Closure: Racial, Gender, and Economic Biases in the Diagnosis of Centrally Mediated Abdominal Pain Syndrome: A Multicenter Retrospective Study

Introduction: Centrally mediated abdominal pain syndrome (CAPS) is a functional disorder characterized by chronic abdominal pain that lacks a structural cause. Because the diagnosis of CAPS is clinical and of exclusion, it demands a thorough diagnostic process. However, disparities based on race, sex, and socioeconomic status may lead to variation in diagnostic rigor. This study aimed to evaluate whether minority and low-income patients, particularly women, are disproportionately and prematurely diagnosed with CAPS, potentially reflecting implicit provider bias. Methods: A retrospective cohort study was conducted across 3 academic medical centers between 2015 and 2023. Adult patients (18 years and older) with a diagnosis of CAPS, identified through International Classification of Diseases-10 coding and confirmed via chart review using Rome IV criteria, were included. Data were collected on race, sex, insurance, and income based on ZIP code. Primary outcomes included time from initial presentation to CAPS diagnosis, the number of diagnostic evaluations performed, and the frequency of specialty referrals. Results: A total of 126 patients met the inclusion criteria, of whom 84.1% (n = 106) were female. Women were significantly more likely to receive a CAPS diagnosis than men (odds ratio 3.7, 95% confidence interval 2.1 to 6.5; P < 0.001). Racial distribution showed that 42.9% were Black, 28.6% Hispanic, 19.0% non-Hispanic White, and 9.5% of other races. Black and Hispanic patients had median times to diagnosis of 4.7 and 5.3 months, compared to 9.6 months for White patients (P < 0.001). Over half of the cohort (57.1%) resided in ZIP codes with incomes below $50,000. These patients experienced shorter times to diagnosis (median 5.0 vs 8.9 months; P = 0.01) and fewer specialty referrals (mean 1.1 vs 2.4; P = 0.03). Additionally, patients with inadequate insurance (62.7% of the cohort) were 2.6 times more likely to receive a CAPS diagnosis without exclusionary testing (P = 0.004). Conclusion: This study reveals that women, especially Black and Hispanic from low-income backgrounds, are disproportionately and prematurely diagnosed with CAPS, often after limited evaluation. These findings raise serious concerns about premature diagnostic closure. Such patterns risk overlooking treatable pathology and may exacerbate disparities. Addressing these inequities will require systemic reforms, such standardized diagnostic protocols, provider training in bias recognition, and improved access to gastroenterology services for underserved populations.