Bonomi Amy E, Anderson Melissa L, Rivara Frederick P, Cannon Elizabeth A, Fishman Paul A, Carrell David, Reid Robert J, Thompson Robert S
Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA.
J Gen Intern Med. 2008 Mar;23(3):294-9. doi: 10.1007/s11606-008-0516-1. Epub 2008 Jan 19.
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.
To examine long-term health care utilization and costs associated with physical, sexual, or both physical and sexual childhood abuse.
Retrospective cohort.
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.
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).
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.
Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.
童年时期遭受身体虐待和性虐待与一生的健康状况不佳有关。然而，从长远来看，这些虐待类型与实际医疗保健使用和费用之间的关联尚无文献记载。
研究与童年时期身体虐待、性虐待或身体与性虐待相关的长期医疗保健利用情况和费用。
回顾性队列研究。
从一个大型综合医疗保健服务系统的会员档案中随机选取3333名女性（平均年龄47岁）。
针对仅遭受身体虐待、仅遭受性虐待或同时遭受身体和性虐待的女性（如在电话调查中报告）以及无这些虐待史的女性（参照组），平均在7.4年的时间里收集自动化的年度医疗保健利用情况和费用数据。
与无类似虐待史的女性相比，有虐待史的女性年度医疗保健使用和费用显著更高。身体和性虐待史兼具的女性的使用情况和费用最为突出。同时遭受两种虐待的女性年度心理健康方面（相对风险[RR]=2.07；95%置信区间[95%CI]=1.67 - 2.57）；急诊科（RR = 1.86；95%CI = 1.47 - 2.35）；医院门诊（RR = 1.35 = 95%CI = 1.10 - 1.65）；药房（发生率比[IRR]=1.57；95%CI = 1.33 - 1.86）；初级保健（IRR = 1.41；95%CI = 1.28 - 1.56）；以及专科护理使用（IRR = 1.32；95%CI = 1.13 - 1.54）均更高。同时遭受两种虐待的女性经调整后的年度医疗保健总费用高出36%，仅遭受身体虐待的女性高出22%，仅遭受性虐待的女性高出16%。
虐待儿童与长期医疗保健使用增加和费用升高有关，尤其是对于同时遭受身体和性虐待的女性。
