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Increased Illness and Health Care Utilization

Jane M. Liebschutz, MD, MPH; Gail Feinman, MS; Lisa Sullivan, PhD; Michael Stein, MD; Jeffrey Samet, MD, MA, MPH

Arch Intern Med. 2000;160:1659-1664.

Background  A history of physical or sexual abuse is associated with increased health care utilization and possibly an increase in illness based largely on self-reported data.

Objective  To examine whether victimization experience is associated with increases in documented medical disease and health care utilization among women infected with the human immunodeficiency virus (HIV).

Methods  We interviewed and reviewed medical record data of 50 women seeking initial primary care for HIV infection at 2 urban hospitals. Women with and without a history of physical and sexual abuse were compared. Using multiple regression analysis, 2 periods were examined: entire life before study entry and the subsequent 2 years. The characteristics examined included episodic disease, chronic disease, sexually transmitted disease, chronic pain syndrome, opportunistic infections, obstetrical history, and number of injuries, surgical procedures, hospitalizations, ambulatory care visits, and emergency department visits.

Results  Evidence of physical or sexual abuse was found in 34 (68%) of the 50 women, of whom 16 (32%) did not disclose during the interview that they were abused. At entry, the rates of episodic disease, chronic pain syndrome, and sexually transmitted disease were greater among those women with histories of abuse. At 2 years, episodic disease, chronic disease, injuries, emergency department visits, and hospitalizations were all more likely in abused women.

Conclusion  Physical and sexual abuse are common and associated with increased medical disease and health care utilization among HIV-infected women.

From the Section of General Internal Medicine and Clinical AIDS Program, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Mass (Drs Liebschutz, Sullivan, and Samet); University of Colorado Health Sciences Center, School of Medicine, Denver (Dr Feinman); and Rhode Island Hospital, Brown University School of Medicine, Providence (Dr Stein).

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