Intimate Partner Violence in Ohio Associations with Health

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Intimate Partner Violence in Ohio: Associations with Health Outcomes and Care Utilization Kenneth J.

Intimate Partner Violence in Ohio: Associations with Health Outcomes and Care Utilization Kenneth J. Steinman, Ph. D, MPH Amy E. Bonomi, Ph. D, MPH 2008 Ohio Family Health Survey June 1, 2009

Questions • How common is p-IPV? • Do people with p-IPV have worse health?

Questions • How common is p-IPV? • Do people with p-IPV have worse health? • Do people with p-IPV use more health care? – Does this association vary by insurance status? • So what?

Ohio Family Health Survey • • • September 2008 -January 2009 n=50, 944 (23,

Ohio Family Health Survey • • • September 2008 -January 2009 n=50, 944 (23, 083 women <65) Computer-assisted telephone interviews Random digit dialing Over-sampling of ethnic minorities, select counties • Representative of Ohio adults & households

IPV measure • During the past 12 months, how many times, if any, has

IPV measure • During the past 12 months, how many times, if any, has anyone hit, slapped, pushed, kicked or physically hurt you? • Think about the time of the most recent incident involving a person or persons who hit, slapped, pushed, kicked or physically hurt you. What was that person’s relationship to you? (open-ended)

Classifying p-IPV How many times…? 0 times Not a case 1+ times What was

Classifying p-IPV How many times…? 0 times Not a case 1+ times What was that person’s relationship to you? 04 Male/Female first date 05 Someone you were dating 06 Former boyfriend/girlfriend 07 Current boyfriend/girlfriend or fiancé 08 Spouse or live-in partner 09 Former spouse or live-in partner Intimate partner violence 01 Stranger 02 Coworker 03 Professional caretaker 10 S/he is my Child 11 S/he is my Stepchild 12 Another family member 13 Acquaintance/friend 97 OTHER 98 DK 99 REFUSED Other violence

Other Variables • Age, ethnicity, region • Socioeconomic status – Income, education, home ownership

Other Variables • Age, ethnicity, region • Socioeconomic status – Income, education, home ownership • Insurance status – Uninsured; Medicaid; Employer-based; Other

Data Analysis • Bivariate association – Covariates with IPV – IPV with dependent variables

Data Analysis • Bivariate association – Covariates with IPV – IPV with dependent variables • Generalized Linear Model – Poisson distribution, log link – Controlling for age, ethnicity, SES • Weighted data; complex survey design

How common is p-IPV?

How common is p-IPV?

Estimated counts of past-year physical intimate partner violence in Ohio • Women: 66, 000

Estimated counts of past-year physical intimate partner violence in Ohio • Women: 66, 000 • Men: 33, 000 • Children living in IPV homes: 58, 000

Prevalence of past-year physical intimate partner violence among Ohio women by age group

Prevalence of past-year physical intimate partner violence among Ohio women by age group

Prevalence of past-year physical intimate partner violence among Ohio women (ages 18 -64): Differences

Prevalence of past-year physical intimate partner violence among Ohio women (ages 18 -64): Differences by insurance type

# of Ohio women experiencing past-year physical intimate partner violence: Estimated counts by age

# of Ohio women experiencing past-year physical intimate partner violence: Estimated counts by age group and insurance type (N=66, 084) 35+ 18 -34

Ohio children living in homes where physical intimate partner violence occurs: Estimated counts by

Ohio children living in homes where physical intimate partner violence occurs: Estimated counts by insurance type

Do people with p-IPV have worse health outcomes?

Do people with p-IPV have worse health outcomes?

Prevalence of health behaviors and outcomes among Ohio women (ages 18 -64): Differences by

Prevalence of health behaviors and outcomes among Ohio women (ages 18 -64): Differences by exposure to physical intimate partner violence

Prevalence of health behaviors and outcomes among Ohio men (ages 18 -64): Differences by

Prevalence of health behaviors and outcomes among Ohio men (ages 18 -64): Differences by exposure to physical intimate partner violence Unstable estimate

Do people with p-IPV use more health care?

Do people with p-IPV use more health care?

Association of IPV with health care utilization among Ohio women (ages 18 -64) Use

Association of IPV with health care utilization among Ohio women (ages 18 -64) Use Prevalence Adjusted* Prevalence Ratio Among women with p-IPV Among women with no violence Estimate 95% CI Urgent care 32. 6% 15. 6% 1. 6 [1. 3 -2. 1] Emergency room 51. 7% 23. 2% 1. 5 [1. 3 -1. 7] Hospital admission 25. 4% 15. 2% 1. 3 [1. 0 -1. 7] *Adjusted for age, ethnicity, income, education, home ownership, insurance status

Does this association vary by insurance type?

Does this association vary by insurance type?

Association of IPV with Health Care Utilization among Ohio women (ages 18 -64): Variation

Association of IPV with Health Care Utilization among Ohio women (ages 18 -64): Variation by Insurance Status Uninsured Medicaid Employer. Based (n=2, 924) (n=2, 998) (n=13, 763) PRR 95% CI Urgent care 2. 3 [1. 5 -3. 5] 1. 4 [1. 0 -1. 9] 1. 3 [0. 8 -2. 4] Emergency room 1. 7 [1. 3 -2. 3] 1. 4 [1. 1 -1. 7] 1. 4 [0. 9 -2. 2] Hospital admission 1. 2 [0. 6 -2. 4] 1. 1 [0. 8 -1. 6] 1. 1 [0. 6 -2. 0] PRR=Prevalence Ratio (adjusted for age, ethnicity, income, education, home ownership)

So What?

So What?

Implications • Medicaid must “own” IPV – Support prevention and intervention • Will expanding

Implications • Medicaid must “own” IPV – Support prevention and intervention • Will expanding employer-based insurance reduce p-IPV-related health care use? • Urgent care may important source for uninsured • Compare service reports to OFHS data – Are we adequately reaching everyone?

Future Research • IPV-care use association among women with employer-based insurance – Distinguish those

Future Research • IPV-care use association among women with employer-based insurance – Distinguish those with spouse-based insurance • Patterns of help-seeking • Association with child health care utilization

Thank you

Thank you

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