Journal of General Internal Medicine

, Volume 23, Issue 3, pp 294–299 | Cite as

Health Care Utilization and Costs Associated with Childhood Abuse

  • Amy E. BonomiEmail author
  • Melissa L. Anderson
  • Frederick P. Rivara
  • Elizabeth A. Cannon
  • Paul A. Fishman
  • David Carrell
  • Robert J. Reid
  • Robert S. Thompson
Original Article



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.


health care utilization costs childhood abuse physical abuse sexual abuse 



This manuscript was developed under the Agency for Healthcare Research and Quality grant: Long-term impact of domestic violence. The authors thank the study interviewers for interviewing thousands of women.

Conflicts of interests

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Amy E. Bonomi
    • 1
    • 2
    Email author
  • Melissa L. Anderson
    • 3
  • Frederick P. Rivara
    • 4
    • 5
    • 6
  • Elizabeth A. Cannon
    • 1
  • Paul A. Fishman
    • 3
  • David Carrell
    • 3
  • Robert J. Reid
    • 3
  • Robert S. Thompson
    • 3
  1. 1.Human Development and Family ScienceThe Ohio State UniversityColumbusUSA
  2. 2.Columbus Children’s Research InstituteColumbusUSA
  3. 3.The Center for Health StudiesGroup Health CooperativeSeattleUSA
  4. 4.Harborview Injury Prevention and Research CenterSeattleUSA
  5. 5.Department of PediatricsUniversity of WashingtonSeattleUSA
  6. 6.Department of EpidemiologyUniversity of WashingtonSeattleUSA

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