COVID-19 and sexual assault: trends in US emergency department visits-a cross-sectional analysis

Sexual assault often increases during crises, yet trends in United States (US) emergency department (ED) visits for sexual assault during COVID-19 remain unclear.

To examine demographic, incident and injury trends in US sexual assault presentations during early and late COVID-19 compared with pre-COVID-19.

This study analysed National Electronic Injury Surveillance System All Injury Programme (2014-2021) retrospective data. ED visits for assault (n=246 499) and sexual assault (n=22 752) were compared across pre-COVID-19 (January 2014-March 2020), early COVID-19 (March 2020-January 2021) and late COVID-19 (February 2021-December 2021). Demographic and injury trends were analysed via t-tests, analysis of variance or χ² tests, with national trends assessed using Joinpoint regression and weighted data in SUDAAN.

From 2017 to 2021, while assault-related ED visits declined (-5.05% annually; p=0.003), sexual assault ED visits remained stable (-1.15% annually; p=0.57). During COVID-19, sexual assault cases decreased among 0-19 years (46.1% pre-COVID-19 to 37.3% late COVID-19) but increased among 20-34 years (36.0% to 40.3%) and 35-64 years (17.2% to 21.0%). From early to late COVID-19, cases increased among black (31.7% to 32.8%) and Hispanic (13.8% to 15.6%) populations but declined among white populations (49.5% to 47.7%). Assaults by parents (9.0% to 11.2%) and partners (10.9% to 13.5%) increased, as did poisoning-related (1.4% to 5.5%) and anoxia-related injuries (0.1% to 0.7%).

Despite the pandemic, ED visits for sexual assault persisted, with demographic shifts and increased injury severity (eg, drug-facilitated violence, strangulation-related anoxia). These findings highlight the need for targeted interventions during public health crises.