Health care utilization and costs associated with childhood abuse

Abstract

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. © 2008 Society of General Internal Medicine.