title: 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.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA. bonomi.1@osu.edu
authors.forename: Amy E
authors.initials: AE
authors.lastname: Bonomi
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cannon
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fishman
authors.forename: David
authors.initials: D
authors.lastname: Carrell
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.forename: Robert S
authors.initials: RS
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002648:Child; D002649:Child Abuse / Q000191:economics* / Q000706:statistics & numerical data*; D002650:Child Abuse, Sexual / Q000191:economics / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D016387:Women's Health