Health Care Use

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Health Care Use Costs Associated with Child
Abuse

• Amy E. Bonomi, PhD, MPH
• The Ohio State University
• bonomi.1_at_osu.edu

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Collaborators

• Group Health Cooperative (Seattle, WA)
• Melissa L. Anderson, MS
• Robert S. Thompson, MD
• Robert Reid, MD, PhD
• Paul Fishman, PhD
• University of Washington (Seattle)
• Frederick P. Rivara, MD, MPH

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Prior Studies of Child Abuse Costs

• 18 higher annual health care costs in women with
  sexual abuse history (Walker 1999)
• 93 higher for women with sexual physical abuse
  (Tang 2006)
• Costs actual health care use associated with
  specific abuse types unknown

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Study Objective

• Estimate health care use costs associated with
  child abuse
• By type of child abuse (physical, sexual, or
  both)
• Into late middle age

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Study Design Sample

• Retrospective cohort
• 3,333 women
• Randomly sampled from Group Health Cooperative
  enrollment records
• Participated in telephone survey to assess abuse
  history / health
• Accessed automated health care use data

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Child Abuse Assessment

• Before you were 18, were you punched, kicked,
  choked, or did you receive more serious
  punishment
• anyone ever touch you in a sexual place or make
  you touch them when you did not want to

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Child Abuse Exposures

• Physical only
• Sexual only
• Physical and sexual abuse
• No physical or sexual (reference group)

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Annual Health Care Use

• Assembled from automated health plan data from 1
  Jan 1992 to 31 Dec 2002
• Services assessed
• Primary care
• Specialty care
• Mental health
• Pharmacy
• Inpatient
• Emergency department

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Annual Health Care Costs

• Allocated for each unit of service delivered
• Adjusted to 2004 U.S. dollars using Consumer
  Price Index for Seattle/Tacoma

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Statistical Analysis

• Unadjusted annual health care use costs
• Multivariable analysis / generalized estimating
  equations
• Health care use
• Any use (relative risks)
• How much used (incident rate ratios)
• Costs (cost ratios)
• Adjusted for age, education, calendar year

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Womens Characteristics
p
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Unadjusted Annual Costs (U.S. )
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Adjusted Cost Ratios
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NS
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NS
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Summary

• Most pronounced health care use costs observed
  for women with physical and sexual abuse
• Yet women with a history of either abuse type
  also had elevated service use costs across
  multiple areas
• Concerning is mental health use by women with
  physical abuse histories

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Limitations

• Reliance on retrospective abuse reports may have
  underestimated effects
• Did not ask about other types of abuse, which
  could confound findings
• Generalizability may be limited due to employed /
  educated nature of sample

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Clinical Implications

• Primary prevention parenting skills programs
• Secondary prevention evaluation by mental
  health professionals
• Care in adulthood screen high users of mental
  health services for child abuse history