Transcript Risk Factors for Femicide in Abusive Relationships

Tracking Intimate Partner Violence in
New York City: Emergency Department,
Hospitalization, & Death Data
Catherine Stayton, DrPH, MPH
Director,
Injury Epidemiology Unit, Bureau of Epidemiology Services
New York City Department of Health & Mental Hygiene,
With Carolyn Olson & Fatima Ashraf
November 9, 2006
Objectives
1. Discuss the measurement challenges of
intimate partner violence (IPV) research
2. Provide overview of IPV surveillance
methodology at the DOHMH
3. Present trends & current burden of IPV
in New York City
4. Describe the violence and its ramifications
DEFINITION
AND
MEASUREMENT
IPV Definition (1)
 Any
violent or coercive behavior, including
physical, sexual and psychological abuse,
perpetrated by someone who is or was
involved in an intimate relationship with the
victim
 “Intimate”
refers to a current or former partner,
including common-law husbands, boyfriends,
girlfriends, lovers, dating partners, etc.
IPV Definition (2)

Physical IPV includes but is not limited to kicking,
punching, slapping or choking with the intent to
cause injury or harm.

Sexual IPV involves engaging in unwanted and/or
coerced sexual acts.

Psychological IPV involves threatening to hit or
to use weapons, continually criticizing, and
controlling access to family, friends, work, and
money.
“Universe” of Intimate Partner Violence
Unknown/unreported
Known
to
health
Known
to
justice
Identified in
population- based
surveys
Health Indicators of
Intimate Partner Violence
Deaths
Hospitalizations
Emergency department visits
Outpatient visits
IPV not resulting in health care encounters
IPV SURVEILLANCE
METHODOLOGY
NYC DOHMH Data Sources
Injury Surveillance System
 Deaths – Office of the Chief Medical Examiner
(OCME)
 Hospitalizations – New York Statewide
Planning and Research Cooperative System
(SPARCS) & active surveillance (in its pilot
phase)
 Emergency Department – treated and released
Survey data sources
 Community Health Survey (CHS)
 Youth Risk Behavior Survey (YRBS)
Female Homicide Surveillance
Data on all female homicide victims (12 yrs+)
obtained from the Office of the Chief Medical
Examiner (OCME) records
 Records include autopsy, crime scene, police
reports, as well as demographic characteristics
of both the victim and offender
 Standardized coding techniques used to
abstract information on assault circumstances
and the relationship between the victim and
alleged offender

Task & Timeline: Female
Homicide Surveillance
Mar ‘06
IRB Approval
Aug ‘06
Receive OCME numbers of female
homicides from Vital Stats
Sep ‘06
Data abstraction from OCME files
Oct ‘06
Data entry and clean-up
Nov ‘06
Preliminary analyses
Round 2, OCME numbers
& data abstraction
Dec ‘06
Jan ‘07
Final analyses
Feb ‘07
Share
findings
Female Assault Hospitalization
Surveillance (Pilot)

SAMPLE: 2002 & 2003 assault hospitalizations
among women (12 yrs+) identified through SPARCS
& corresponding assault case medical records
obtained from a sample of 23 hospitals

DATA COLLECTION: Identified medical records
reviewed for assault circumstances & victimperpetrator relationship

ANALYSIS: citywide counts and rates estimated
from this sample
Emergency Department
Surveillance

SAMPLE: 23 hospitals accounting for ~75% of
assault hospitalization volume & we select one
week per season; we then look at all ED charts
for those 4 weeks at the 23 hospitals

DATA COLLECTION: demographics,
circumstance of assault, relationship between
perpetrator and victim

ANALYSIS: citywide counts and rates estimated
from this sample
Categorizing violence against
women, across injury data sources
 Intimate
 Family
- brother, step-father, daughter-inlaw, etc.
 Other
violence - robberies, fights at bars,
drive-by shootings, etc.
 In
some cases, circumstance surrounding
the crime unknown or undocumented
Community Health Survey

Annual random-digit dial survey of
approximately 10,000 NYC adults ages 18 and
older

QUESTION: In the past 12 months, have you
been frightened for the safety of yourself, your
children or friends because of the anger or
threats of an intimate partner?
SURVEILLANCE FINDINGS:
Trends
Current burden
Risk factors
Circumstances
Health correlates
NYC's Female Homicide Rates,
1999 to 2004
Overall
Intimate Partner Homicide
3.5
3
3.1
2.9
2.9
Deaths/100,000
2.5
2.7
2.6
2.6
2
1.5
1
0.9
0.9
1.2
0.9
0.9
1.0
0.5
0
1999
Age-adjusted rates
2000
2001
2002
2003
2004
Assault-Related ED Visit Rates among
Women, New York City, 1999 to 2004
475
450
447.9
464.5
425
400
375
391.4
ED Visits/100,000
350
325.5
357.5
Overall
325
300
275
248
Intimate
Partner
Violence
250
225
200
175
150
125
100
75
106.9
99.1
87.9
100.1
80.5
65.7
50
1999
Age-adjusted rates
2000
2001
2002
2003
2004
Type of Violence against Women in NYC by
Injury Surveillance Data Source
100%
23
80%
37
IPV
32
9
Family Violence (e.g.,
brother, step-father,
daughter-in-law)
8
60%
7
32
20
40%
20%
Other Violence (e.g.,
robberies, fights at bars,
drive-by shootings)
40
Unknown
36
36
20
0%
Female Homicides (2002-2004)
Average ≈100
Hospitalizations (2002-2003)
Average ≈ 750
ED visits (2002-2004)
Average ≈ 15,650
% of cases that involved
sexual violence
IPV cases only
9
8
7
6
5
4
3
2
1
0
8.0
6
7.5
5.3
4.8
5
P er c en t
P e r ce n t
All Cases
4.4
4
3
2
1.1
1
0
Female Homicide
(2002-2004)
Female Assault
Hospitalizations
(2002-2003)
ED Visits
(2002-2004)
Female Homicide
(2002-2004)
Female Assault
Hospitalizations
(2002-2003)
ED Visits
(2002-2004)
IPV Burden – Recent* Snapshot
IPV-related female homicide IPV-related ED visits (20022004)
(2002-2004)
 37
 estimated 3,600 ED visits
 1 death per 100,000
 95.8 per 100,000
Self-reported fear (2002-2004)
IPV-related
Hospitalizations (2002-2003)  2.6%
 almost 85,000 women over
 estimated 240
18 years old
 6.7 per 100,000
* Annual averages & age-adjusted rates
Who is most affected by IPV?

AGE: younger women (in particular, 20 to 29
year olds)

RACE/ETHNICITY: Black and Hispanic
women

SOCIOECONOMIC FACTOR: women living
in neighborhoods with very low average
household income

BOROUGH: Brooklyn and Bronx residents
Who perpetrates intimate
partner violence (IPV)?
Homicides, 2002-2004
O ther *,
7%
Hospitalizations, 2002-2003
Exhu s b a nd,
9%
Other*,
9%
Exb oyf r iend,
13%
Exhusband,
2%
Exboyfriend,
7%
Boyf r iend,
27%
Husband ,
27%
Boyfriend,
55%
H u s b a nd ,
44%
Most fatal & non-fatal IPV occurs at home
Female Homicide (2002-2004)
Hospitalizations (2002-2003)
ED visits (2002-2004)
100
88
90
82
80
77
70
Percent
60
50
40
30
18
20
10
10
4
7
6
1
0
0
0
1
1
0
Home
Age-adjusted proportions
Street/outside
Workplace
School
Other
5
Proportion of Intimate Partner Violence
Incidents Documented as Being
Witnessed by Children in New York City
Intimate partner homicides
(2002-2004)
13%
IPV-related hospitalizations
6%
(2002-2003)
Clinical manifestations of IPV
CHS survey data
IPV+
IPV-
%
%
Mental health indicators
Serious psychological distress
23.4
6.9
Had >5 drinks in a row on > 1 day in
past month
12.4
7.9
3 or more sexual partners in past
year
10.8
2.6
Diabetes
14.8
8.7
Asthma
12.1
6.1
Risk behaviors
Health status