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Health care utilization and costs associated with childhood abuse
Amy E Bonomi1, Melissa L Anderson, Frederick P Rivara
1Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA. bonomi.1@osu.edu
Insights
Childhood physical and sexual abuse significantly increases long-term healthcare utilization and costs for women. Women experiencing both types of abuse incurred the highest healthcare expenses.
Area of Science:
- Public Health
- Health Services Research
- Trauma Studies
Background:
- Childhood physical and sexual abuse are linked to adverse health outcomes throughout life.
- The long-term impact of childhood abuse on healthcare utilization and costs remains under-documented.
Purpose of the Study:
- To investigate the long-term associations between childhood physical, sexual, or combined abuse and subsequent healthcare use and expenditures.
- To quantify the impact of different types of childhood abuse on healthcare costs over time.
Main Methods:
- A retrospective cohort study design was employed.
- Data were collected from 3,333 women (average age 47) within a large healthcare system.
- Automated health records over 7.4 years tracked utilization and costs for women with and without reported childhood abuse histories.
Main Results:
- Women with any history of childhood abuse exhibited significantly higher annual healthcare use and costs compared to the reference group.
- The most substantial increases in healthcare utilization and costs were observed in women with a history of both physical and sexual childhood abuse.
- Specific increases included mental health services (RR=2.07), emergency department visits (RR=1.86), and pharmacy costs (IRR=1.57). Total annual costs were 36% higher for women with both abuse types.
Conclusions:
- Childhood abuse has a significant and lasting impact on healthcare utilization and associated costs.
- Women who experienced both physical and sexual abuse in childhood face the most pronounced long-term increases in healthcare use and expenses.
- Findings underscore the importance of addressing childhood abuse to mitigate long-term health and economic consequences.
Background:
Physical and sexual childhood abuse is associated with poor health across the lifespan. However, the association between these types of abuse and actual health care use and costs over the long run has not been documented.
Objective:
To examine long-term health care utilization and costs associated with physical, sexual, or both physical and sexual childhood abuse.
Design:
Retrospective cohort.
Participants:
Three thousand three hundred thirty-three women (mean age, 47 years) randomly selected from the membership files of a large integrated health care delivery system.
Measurements:
Automated annual health care utilization and costs were assembled over an average of 7.4 years for women with physical only, sexual only, or both physical and sexual childhood abuse (as reported in a telephone survey), and for women without these abuse histories (reference group).
Results:
Significantly higher annual health care use and costs were observed for women with a child abuse history compared to women without comparable abuse histories. The most pronounced use and costs were observed for women with a history of both physical and sexual child abuse. Women with both abuse types had higher annual mental health (relative risk [RR] = 2.07; 95% confidence interval [95%CI] = 1.67-2.57); emergency department (RR = 1.86; 95%CI = 1.47-2.35); hospital outpatient (RR = 1.35 = 95%CI = 1.10-1.65); pharmacy (incident rate ratio [IRR] = 1.57; 95%CI = 1.33-1.86); primary care (IRR = 1.41; 95%CI = 1.28-1.56); and specialty care use (IRR = 1.32; 95%CI = 1.13-1.54). Total adjusted annual health care costs were 36% higher for women with both abuse types, 22% higher for women with physical abuse only, and 16% higher for women with sexual abuse only.
Conclusions:
Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.
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