title: Is there a relationship between lacking a primary care provider and child abuse?
abstract: OBJECTIVE
  To examine the association between lacking a primary care provider and child abuse.
  
  
  METHODS
  We conducted a secondary data analysis of 1462 children aged </=19 years presenting for suspected physical/sexual abuse to a child advocacy center (CAC) at an academic medical center. Children were stratified by age. The key independent variable was having a primary care provider. The dependent variable was abuse: confirmed, suspected, or ruled out. Multivariate models were adjusted for sociodemographic factors and referral source.
  
  
  RESULTS
  Children aged </=2 years without a primary care provider were more than 4 times as likely to have confirmed/suspected abuse of either type, compared with children with a provider, after adjusting for sociodemographic factors (adjusted odds ratio: 4.41; 95% confidence interval, 1.38-14.13). This relationship was also significant when looking only at children evaluated for physical abuse, but not for children evaluated for sexual abuse. Although there continued to be an association between lacking a provider and abuse, especially physical abuse, for children </=2.5 years of age there was no association after this age. For sexual abuse, there was no association between lacking a primary care provider and sexual abuse for children of any age.
  
  
  CONCLUSIONS
  Among young children aged </=2.5 years presenting to a CAC, we found an association between lacking a primary care provider and child abuse, particularly physical abuse. The significance of this association deserves further study.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. mss2112@columbia.edu
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Stockwell
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Brown
authors.forename: Shaofu
authors.initials: S
authors.lastname: Chen
authors.forename: Matilde
authors.initials: M
authors.lastname: Irigoyen
mesh_terms: D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors