Health care use of children whose female caregivers have intimate partner violence histories.

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.