Health care utilization and costs associated with physical and nonphysical-only intimate partner violence.
OBJECTIVE
To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse.


METHODS
A total of 3,333 women (ages 18-64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group).


RESULTS
Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women-with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women.


CONCLUSIONS
Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization.
Bonomi
Amy E
AE
Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA. bonomi.1@osu.edu
Anderson
Melissa L
ML
Rivara
Frederick P
FP
Thompson
Robert S
RS
D000328:Adult; D000704:Analysis of Variance; D018585:Battered Women / Q000523:psychology / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D017281:Cost of Illness; D004651:Employment / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008875:Middle Aged; D015205:Northwestern United States / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000145:classification / Q000191:economics* / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D013997:Time Factors; D055815:Young Adult
Am J Prev Med. 2007 Feb;32(2):89-96
17234483
Arch Intern Med. 2002 May 27;162(10):1157-63
12020187
Womens Health. 1995 Winter;1(4):273-88
9373384
Am J Prev Med. 2003 Jan;24(1):9-15
12554018
BMJ. 1992 Jul 4;305(6844):27-8
1638194
Violence Vict. 2004 Jun;19(3):259-72
15631280
Violence Vict. 2005 Aug;20(4):379-91
16250406
Am J Public Health. 2000 Apr;90(4):553-9
10754969
Ann Epidemiol. 2008 Jul;18(7):538-44
18495490
HMO Pract. 1992 Mar;6(1):13-9
10119658
Womens Health Issues. 1992 Fall;2(3):154-63
1422244
J Womens Health (Larchmt). 2007 Sep;16(7):987-97
17903075
Am J Prev Med. 2006 Jun;30(6):458-66
16704938
Health Serv Res. 1991 Apr;26(1):53-74
1901841
Am J Prev Med. 2006 Jun;30(6):447-57
16704937
JAMA. 2003 Feb 5;289(5):589-600
12578492
Ann Emerg Med. 2002 Jan;39(1):31-8
11782728
Med Care. 1991 May;29(5):452-72
1902278
Lancet. 2008 Apr 5;371(9619):1165-72
18395577
J Health Soc Behav. 1995 Mar;36(1):1-10
7738325
N Z Med J. 2004 Nov 26;117(1206):U1173
15570342
Am J Prev Med. 2002 Nov;23(4):260-8
12406480
Public Health Rep. 2004 Nov-Dec;119(6):557-67
15504447
Womens Health Issues. 2006 Sep-Oct;16(5):252-61
17055378
Pharmacoepidemiol Drug Saf. 2005 Dec;14(12):877-84
15931653
Nurs Res. 2005 Jul-Aug;54(4):235-42
16027566