Child maltreatment and health service use in two different social contexts

Background: Adults who experience abuse as children have a higher use of medical health services in adulthood compared to those not abused. However, among children, those who experience abuse have lower immunization rates and are less likely to have a primary care provider. We examined the relation between child abuse and health service use among Puerto Rican children.

Methods: Parents and children participating in the Boricua Youth Study, a longitudinal study of Puerto Rican youth residing in the Bronx, NY (N=1116) and San Juan, Puerto Rico (N=1339) completed reports of child physical, sexual and emotional abuse. Parents reported if the child had visited a doctor, hospital or clinic because the child was ill, was injured or for routine care.

Results: Mean age was 9 years and 51% were boys, 26% of children in NY reported abuse vs. 23% in PR. Models were stratified by site and adjusted for sociodemographic factors. In PR, children who experienced one type of abuse (OR 1.6 95% CI 1.1, 2.3) or two or more (OR 1.9 95%CI 1.1, 3.2) were more likely to report an injury visit. In the Bronx, children who experienced two or more types (OR 2.0 95%CI 1.1, 3.6) were more likely to report an illness visit. No relation between child abuse and routine service use was noted in either site.

Conclusion: Whether for illness or injury, children who experience abuse, frequently come in contact with health care providers, presenting opportunities for intervention and the prevention of further abuse.