Intimate partner violence-related hospitalizations in Appalachia and the non-Appalachian United States

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Abstract

The highly rural region of Appalachia faces considerable socioeconomic disadvantage and health disparities that are recognized risk factors for intimate partner violence (IPV). The objective of this study was to estimate the rate of IPV-related hospitalizations in Appalachia and the non-Appalachian United States for 2007–2011 and compare hospitalizations in each region by clinical and sociodemographic factors. Data on IPV-related hospitalizations were extracted from the State Inpatient Databases, which are part of the Healthcare Cost and Utilization Project. Hospitalization day, year, in-hospital mortality, length of stay, average and total hospital charges, sex, age, payer, urban-rural location, income, diagnoses and procedures were compared between Appalachian and non-Appalachian counties. Poisson regression models were constructed to test differences in the rate of IPV-related hospitalizations between both regions. From 2007–2011, there were 7,385 hospitalizations related to IPV, with one-third (2,645) occurring in Appalachia. After adjusting for age and rurality, Appalachian counties had a 22% higher hospitalization rate than non-Appalachian counties (ARR = 1.22, 95% CI: 1.14–1.31). Appalachian residents may be at increased risk for IPV and associated conditions. Exploring disparities in healthcare utilization and costs associated with IPV in Appalachia is critical for the development of programs to effectively target the needs of this population.

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Most cited references 52

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Health consequences of intimate partner violence.

Jacquelyn Campbell (2002)

Intimate partner violence, which describes physical or sexual assault, or both, of a spouse or sexual intimate, is a common health-care issue. In this article, I have reviewed research on the mental and physical health sequelae of such violence. Increased health problems such as injury, chronic pain, gastrointestinal, and gynaecological signs including sexually-transmitted diseases, depression, and post-traumatic stress disorder are well documented by controlled research in abused women in various settings. Intimate partner violence has been noted in 3-13% of pregnancies in many studies from around the world, and is associated with detrimental outcomes to mothers and infants. I recommend increased assessment and interventions for intimate partner violence in health-care settings.

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Intimate partner violence and physical health consequences.

Jacquelyn Campbell, Alison Jones, Jacqueline Dienemann … (2002)

Domestic violence results in long-term and immediate health problems. This study compared selected physical health problems of abused and never abused women with similar access to health care. A case-control study of enrollees in a multisite metropolitan health maintenance organization sampled 2535 women enrollees aged 21 to 55 years who responded to an invitation to participate; 447 (18%) could not be contacted, 7 (0.3%) were ineligible, and 76 (3%) refused, yielding a sample of 2005. The Abuse Assessment Screen identified women physically and/or sexually abused between January 1, 1989, and December 31, 1997, resulting in 201 cases. The 240 controls were a random sample of never abused women. The general health perceptions subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey measured general health. The Miller Abuse Physical Symptom and Injury Scale measured abuse-specific health problems. Cases and controls differed in ethnicity, marital status, educational level, and income. Direct weights were used to standardize for comparisons. Significance was tested using logistic and negative binomial regressions. Abused women had more (P<.05) headaches, back pain, sexually transmitted diseases, vaginal bleeding, vaginal infections, pelvic pain, painful intercourse, urinary tract infections, appetite loss, abdominal pain, and digestive problems. Abused women also had more (P< or =.001) gynecological, chronic stress-related, central nervous system, and total health problems. Abused women have a 50% to 70% increase in gynecological, central nervous system, and stress-related problems, with women sexually and physically abused most likely to report problems. Routine universal screening and sensitive in-depth assessment of women presenting with frequent gynecological, chronic stress-related, or central nervous system complaints are needed to support disclosure of domestic violence.

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Physical health consequences of physical and psychological intimate partner violence.

A L Coker (2000)

Past studies that have addressed the health effects of intimate partner violence (IPV) have defined IPV as violence based on physical blows that frequently cause injuries. To our knowledge, no epidemiologic research has assessed the physical health consequences of psychological forms of IPV. To estimate IPV prevalence by type and associated physical health consequences among women seeking primary health care. Cross-sectional survey. A total of 1152 women, aged 18 to 65 years, recruited from family practice clinics from February 1997 through January 1999 and screened for IPV during a brief in-clinic interview; health history and current status were assessed in a follow-up interview. Of 1152 women surveyed, 53.6% ever experienced any type of partner violence; 13.6% experienced psychological IPV without physical IPV. Women experiencing psychological IPV were significantly more likely to report poor physical and mental health (adjusted relative risk [RR], 1.69 for physical health and 1.74 for mental health). Psychological IPV was associated with a number of adverse health outcomes, including a disability preventing work (adjusted RR, 1.49), arthritis (adjusted RR, 1.67), chronic pain (adjusted RR, 1.91), migraine (adjusted RR, 1.54) and other frequent headaches (adjusted RR, 1.41), stammering (adjusted RR, 2.31), sexually transmitted infections (adjusted RR, 1.82), chronic pelvic pain (adjusted RR, 1.62), stomach ulcers (adjusted RR, 1.72), spastic colon (adjusted RR, 3.62), and frequent indigestion, diarrhea, or constipation (adjusted RR, 1.30). Psychological IPV was as strongly associated with the majority of adverse health outcomes as was physical IPV. Psychological IPV has significant physical health consequences. To reduce the range of health consequences associated with IPV, clinicians should screen for psychological forms of IPV as well as physical and sexual IPV.

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Author and article information

Contributors

Danielle M. Davidov:

ORCID: http://orcid.org/0000-0002-6754-6724

Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Stephen M. Davis: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: MethodologyRole: SoftwareRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Motao Zhu: Role: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Tracie O. Afifi: Role: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Melissa Kimber: Role: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Abby L. Goldstein: Role: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Nicole Pitre: Role: Funding acquisitionRole: Writing – original draftRole: Writing – review & editing

Kelly K. Gurka: Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Carol Stocks: Role: Data curationRole: Formal analysisRole: InvestigationRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Virginia J. Vitzthum: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 8 September 2017

Publication date Collection: 2017

Volume: 12

Issue: 9

Electronic Location Identifier: e0184222

Affiliations

[1 ] Department of Emergency Medicine and Social and Behavioral Sciences, West Virginia University, Morgantown, West Virginia, United States of America

[2 ] Department of Social and Behavioral Sciences, West Virginia University, Morgantown, West Virginia, United States of America

[3 ] Department of Epidemiology, West Virginia University, Morgantown, West Virginia, United States of America

[4 ] Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada

[5 ] Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

[6 ] Department of Applied Psychology and Human Development, OISE, University of Toronto, Toronto, Ontario, Canada

[7 ] Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada

[8 ] Agency for Healthcare Research and Quality, Rockville, Maryland, United States of America

Indiana University, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

[¤a]

Current address: Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America

[¤b]

Current address: Department of Pediatrics, Ohio State University, Columbus, Ohio, United States of America

[¤c]

Current address: Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America

* E-mail: ddavidov@ 123456hsc.wvu.edu

Author information

Danielle M. Davidov http://orcid.org/0000-0002-6754-6724

Article

Publisher ID: PONE-D-17-06917

DOI: 10.1371/journal.pone.0184222

PMC ID: 5590902

PubMed ID: 28886119

SO-VID: c48561bb-1132-4a55-9f33-ca89920d7db7

License:

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

History

Date received : 20 February 2017

Date accepted : 21 August 2017

Page count

Figures: 0, Tables: 4, Pages: 17

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100000057, National Institute of General Medical Sciences;

Award ID: U54GM104942

Award Recipient :

ORCID: http://orcid.org/0000-0002-6754-6724

Danielle M. Davidov

Funded by: funder-id http://dx.doi.org/10.13039/501100000029, Institute of Gender and Health;

Award ID: RDG99326

Funded by: Ontario Ministry of Health and Long-Term Care (CA)

Award Recipient : Melissa Kimber

Funded by: Research Manitoba (CA)

Award Recipient : Tracie O. Afifi

Funded by: funder-id http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;

Award Recipient : Tracie O. Afifi

Funded by: funder-id http://dx.doi.org/10.13039/100006545, National Institute on Minority Health and Health Disparities;

Award Recipient :

ORCID: http://orcid.org/0000-0002-6754-6724

Danielle M. Davidov

This research was supported by the Canadian Institutes of Health Research Institute of Gender and Health and Institute of Neurosciences Mental Health and Addictions to the PreVAiL Preventing Violence Across the Lifespan Research Network) (Centre for Research Development in Gender, Mental Health and Violence across the Lifespan, grant #RDG99326). DD is supported by a grant from the National Institute Of General Medical Sciences of the National Institutes of Health under Award Number U54GM104942 and a Loan Repayment Program Grant from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. TA is supported by a Research Manitoba Establishment Award and a Canadian Institutes of Health Research New Investigator Award. MK is supported by a Women’s Health Scholar Post Doctoral Fellowship Award from the Ontario Ministry of Health and Long-Term Care.

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Data Availability The data that support the findings of this study were obtained from intramural State Inpatient Databases' files at the Agency for Healthcare Research and Quality, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Specifically, HCUP data are Limited Data Sets as defined under the HIPAA Privacy Rule and contain protected health information such as county and full ZIP Code. Data from some states participating in HCUP restrict public release by the Agency for Healthcare Research and Quality (AHRQ). However aggregate statistical results based on analyses of the restricted dataset are available from the authors upon request and with permission from the Agency for Healthcare Research and Quality. In the event that verification of findings is necessary, a request for onsite access to data can be submitted to carol.stocks@ 123456ahrq.hhs.gov , or by mail to HCUP Project Officer, Agency for Healthcare Quality and Research, 5600 Fishers Lane, Rockville, MD 20857. As an alternative, requests could be made directly to the HCUP Partner organizations ( https://www.hcup-us.ahrq.gov/partners.jsp).

Intimate partner violence-related hospitalizations in Appalachia and the non-Appalachian United States

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Most cited references 52

Health consequences of intimate partner violence.

Intimate partner violence and physical health consequences.

Physical health consequences of physical and psychological intimate partner violence.

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