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Health Care Use of Children Whose Female Caregivers Have Intimate Partner Violence Histories
Megan H. Bair-Merritt, MD, MSCE;
Chris Feudtner, MD, PhD, MPH;
A. Russell Localio, PhD;
Jamie A. Feinstein, MD;
David Rubin, MD, MSCE;
William C. Holmes, MD, MSCE
Arch Pediatr Adolesc Med. 2008;162(2):134-139.
Objective To determine whether prior exposure to intimate partner violence (IPV) is associated with children's subsequent emergency department (ED) visits and hospitalizations.
Design Retrospective cohort study.
Setting The National Survey of Child and Adolescent Well-Being, a nationally representative sample of children reported to Child Protective Services between 1999 and 2000.
Participants Families of children reported to Child Protective Services who were assessed through comprehensive caregiver interviews at baseline and 18 and 36 months.
Main Exposure Severe or minor IPV, as measured by the Conflict Tactics Scale 1.
Main Outcome Measures Number of ED visits or hospitalizations from baseline to the 18-month assessment (interval 1, n = 2689) and from the 18-month to the 36-month assessment (interval 2, n = 2546).
Results Compared with children whose female caregivers reported no IPV at baseline, children whose female caregivers disclosed severe IPV at baseline had significantly higher rates of ED visits over both subsequent intervals (interval 1, incidence rate ratio [IRR], 2.0; 95% confidence interval [CI], 1.3-2.9; interval 2, IRR, 1.9; 95% CI, 1.2-3.0). In contrast, rates of hospitalizations were lower in the second interval for children whose female caregivers disclosed minor IPV as compared with no IPV at baseline (IRR, 0.2; 95% CI, 0.1-0.6).
Conclusions Further research is required to elucidate the complex relationship between IPV and child health care use. Such an understanding will facilitate identification of sites within the health care system where effective interventions for children exposed to IPV, and their caregivers, might be located.
Author Affiliations: Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland (Dr Bair-Merritt); and Pediatric Generalist Research Group, Division of General Pediatrics, The Children's Hospital of Philadelphia (Drs Bair-Merritt, Feudtner, Feinstein, and Rubin), Center for Health Equity Research and Promotion, Philadelphia Veterans Administration Medical Center (Dr Holmes), Department of Medicine, Hospital of the University of Pennsylvania (Dr Holmes), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, School of Medicine (Drs Feudtner, Localio, Rubin, and Holmes), and The Leonard Davis Institute of Health Economics (Dr Feudtner), University of Pennsylvania, Philadelphia.
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