文章基本信息

标题：The Role of Race/Ethnicity in the Relationship Between Emergency Department Use and Intimate Partner Violence: Findings From the 2002 National Survey on Drug Use and Health
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作者：Sherry Lipsky ; Raul Caetano
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：12
页码：2246-2252
DOI：10.2105/AJPH.2006.091116
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the relationship between intimate partner violence victimization among women in the general population and emergency department use. We sought to discern whether race/ethnicity moderates this relationship and to explore these relationships in race/ethnic–specific models. Methods. We used data on non-Hispanic White, Non-Hispanic Black, and His-panic married or cohabiting women from the 2002 National Survey on Drug Use and Health. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using logistic regression. Results. Women who reported intimate partner violence victimization were 1.5 times more likely than were nonvictims to use the emergency department, after we accounted for race/ethnicity and substance use. In race/ethnic–specific analyses, only Hispanic victims were more likely than their nonvictim counterparts to use the emergency department (AOR = 3.68; 95% CI = 1.89, 7.18), whereas substance use factors varied among groups. Conclusions. Our findings suggest that the emergency department is an opportune setting to screen for intimate partner violence victimization, especially among Hispanic women. Future research should focus on why Hispanic victims are more likely to use the emergency department compared with nonvictims, with regard to socioeconomic and cultural determinants of health care utilization. Intimate partner violence (IPV) against women has been associated with increased healthcare utilization overall 1 ^– 5 and with non–primary care services in particular. 6 ^– 8 For example, nearly 40% of the approximately 4.8 million rape and violent physical incidents perpetrated by intimate partners each year result in injury and about 30% of injured women receive medical care. 7 The majority of these women receive treatment in a hospital setting, with more than half treated in an emergency department. Multiple medical care visits are frequently required for each incident, resulting in nearly 500 000 emergency department visits each year by women victims, as well as costs to consumers, employers, and the public health system of more than $168.5 million per year for emergency department visits alone. 7 Although racial and ethnic disparities in the relationship between IPV and emergency department utilization have not been reported in studies of nonclinical samples, several related paths of research point in this direction. First, the extant literature overall suggests that IPV occurs more frequently among Blacks and, to a lesser extent, Hispan-ics compared with Whites in general population surveys. 9 Second, alcohol use is associated with IPV, especially among Black women. The 1995 National Study of Couples, 10 for example, found that women exposed to male-perpetrated IPV were more likely than were nonexposed women to report alcohol problems and drug use, particularly women of Black or “other” race/ethnicity who experienced severe IPV. Likewise, Cae-tano et al. 11 found social consequences of drinking, but not dependence symptoms, among female partners to be associated with male-to-female IPV only among Black couples. However, White and Chen 12 found a woman’s problem drinking to be associated with her victimization in a study among a predominately White population. All of these analyses controlled for partner drinking. It remains unclear whether substance use precedes or follows IPV, but the current literature suggests that women may “self-medicate” to alleviate the effects of partner violence. 13 ^– 16 Third, race/ethnicity is a factor in the utilization of emergency department services and in alcohol-related emergency department use. Black and Hispanic women are more likely to utilize emergency department and in-patient hospital services compared with non-Hispanic White women, 17 ^– 24 and alcohol-related visits to the emergency department for Blacks are approximately twice that of Whites overall. 25 Further, women’s (and their partners’) use of illicit drugs and alcohol abuse are associated with IPV among ethnic minorities who attend urban emergency departments, with IPV-related injury among women victims in emergency department studies, and with severe IPV in female trauma patients. 26 ^– 30 Taken together, these findings suggest that Black and Hispanic women are more likely than are White women to utilize the emergency department, that Black and Hispanic women who have experienced IPV are more likely than their non-victim counterparts to utilize the emergency department, and that substance abuse may play a role in these relationships. Many of the studies that have addressed the relationship between IPV and emergency department utilization have been clinic- or hospital-based studies. These studies may introduce detection bias by differentially including those individuals who lack access to primary care or those who have the ability to pay (or have insurance) for emergency department services, depending on the socioeconomic status of the population served. 19 ^, 21 ^, 31 ^– 36 Few population-based self-report surveys have examined health care utilization, 37 ^– 39 aside from those focused on IPV incident–specific care, such as the National Violence Against Women Survey conducted 10 years ago. To address these gaps in the literature, we aimed to (1) examine the relationship between IPV victimization among women and emergency department utilization in the general population, while accounting for race/ ethnicity and substance use; (2) discern whether race/ethnicity is a moderator in the relationship between IPV and emergency department use; and (3) examine the relationship between IPV and emergency department use in race/ethnic–specific analyses in the event race/ethnicity was found to be a moderating factor.