Hospitalizations related to family violence and child maltreatment in Appalachia

The culturally and geographically defined region of Appalachia is a historically underserved area of the United States (US). Appalachian communities experience multiple sociodemographic and health-related disparities, many of which are recognized risk factors for family violence. The purpose of the current study was to estimate hospitalizations related to family violence and child maltreatment within Appalachia and describe demographic and clinical characteristics of this population. This retrospective cohort study utilized twelve years (2000-2011) of data from the Nationwide Inpatient Sample. Cases were abstracted using Federal Information Processing Standard (FIPS) codes to denote Appalachian counties and ICD-9-CM codes were used to identify family violence and child maltreatment. From 2000 to 2011, there were an estimated 5,201 hospital stays related to family violence and child maltreatment in the Appalachian region. The mean age was 30 years, 68% were female and over half of the hospital stays were billed to Medicaid. Nearly 35% of hospitalizations occurred in rural locations. Patients residing in communities with the lowest annual median income quartile (<$38,999) accounted for 44% of stays. Intracranial injury, affective and mood disorders, pregnancy complications, fractures of the lower limb, skull, and face and superficial injuries/contusions were the most common diagnoses for adults and children whose exposure to violence and/or child maltreatment was severe enough to necessitate hospitalization. Total costs approached $100 million (mean=$18,712 per hospitalization). The high cost of family violence as demonstrated by these data indicates the need for prevention and intervention programs to effectively target the needs of this underserved population.