Health care utilization and costs associated with physical and nonphysical-only intimate partner violence

Health Serv Res. 2009 Jun;44(3):1052-67. doi: 10.1111/j.1475-6773.2009.00955.x. Epub 2009 Mar 17.


Objective: To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse.

Methods: A total of 3,333 women (ages 18-64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group).

Results: Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women-with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women.

Conclusion: Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Analysis of Variance
  • Battered Women / psychology
  • Battered Women / statistics & numerical data*
  • Case-Control Studies
  • Cost of Illness
  • Employment / economics
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Care Surveys
  • Health Services* / economics
  • Health Services* / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Middle Aged
  • Northwestern United States / epidemiology
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Regression Analysis
  • Socioeconomic Factors
  • Spouse Abuse / classification
  • Spouse Abuse / economics*
  • Spouse Abuse / statistics & numerical data
  • Statistics, Nonparametric
  • Time Factors
  • Young Adult