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To examine the factors associated with time to first analgesic medication in the emergency department. Pain is the most common symptom presenting to the emergency department, and the time taken to deliver analgesic medication is a common outcome measure. Factors associated with time to first analgesic medication are likely to be multifaceted, but currently poorly described. Retrospective cohort study. Cox proportional hazards regression modelling was undertaken to evaluate the associations between person, environment, health and illness