Assessment of Additional Medical Costs Among Older Adults in Japan With a History of Childhood Maltreatment
Assessment of Additional Medical Costs Among Older Adults in Japan With a History of Childhood Maltreatment
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DOI：
10.1001/jamanetworkopen.2019.18681
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发表时间：
2020-01-01
影响因子：
13.8
通讯作者：
Kondo, Katsunori
中科院分区：
文献类型：
--
作者：
Isumi, Aya;Fujiwara, Takeo;Kondo, Katsunori
关键点问题有儿童期虐待史的老年人的医疗费用比没有虐待史的老年人高吗？发现在这项对978名成年人进行的横断面研究中，使用了日本的国家医疗保险索赔数据，那些经历过任何童年虐待的人的平均年医疗费用明显高于没有经历过虐待的人，即使在调整了年龄和性别之后也是如此。在这项研究中，童年虐待与生活在日本的老年人的额外医疗费用相关，这突显了儿童虐待的一级和二级预防的重要性。这项横断面研究评估了童年虐待史是否与日本老年人的额外医疗费用有关。重要的是，童年虐待可以在整个生命过程中对健康产生重大影响，但它与晚年医疗费用的关联并不广为人知。目的评估儿童期虐待史是否与日本老年人的额外医疗费用有关。设计、设置和参与者这项以人口为基础的横断面研究使用了2013年日本老年评估研究的数据，并与参与2013年日本老年评估研究的1个直辖市2012年4月至2014年3月的全国医疗保险索赔数据相关联。该市有超过150万居民，978名年龄在65岁至75岁之间的独立人士被纳入分析范围。对2017年10月至2019年2月的数据进行了分析。暴露儿童虐待，包括身体虐待，情感忽视，情感虐待，以及目睹亲密伴侣的暴力行为。主要结果和措施2012年4月至2013年3月和2013年4月至2014年3月期间的平均年医疗费用。结果978名独立老年人(平均年龄70.6[2.9]岁；男性426名(43.6%))中，44名(4.5%)发生过亲密伴侣暴力事件，19名(1.9%)曾遭受过身体虐待，104名(10.6%)曾在儿童期遭受过情感上的虐待，56名(5.7%)在童年时曾遭受过情感虐待。总体而言，176名老年人(18.0%)经历了至少一种类型的童年虐待。那些经历过任何童年虐待的人的年平均医疗费用显著高于没有经历过的人(差异，136456日元[1255美元]；95%CI，38155-234757日元[351-2160美元]；P=0.007)。那些经历了情感忽视的人比没有经历过情感忽视的人花费了更多的平均医疗费用(差异，161400日元[1484美元]；95%的CI，日元42779-280021[美元394-2576美元]；P=0.008)。在控制了年龄和性别后，儿童期虐待与医疗费用的相关性仍然显著(平均边际效应，116098日元[1068美元]；SE，日元53620[美元493美元]；95%CI，日元11004-221192[101-2034美元]；P=0.03)。据估计，全国每年与儿童期虐待相关的额外成本将超过3330亿日元(310万美元)。结论和相关性在这项研究中，在居住在日本的老年人中，童年虐待与额外的医疗费用有关。这一调查结果强调了一级和二级预防虐待儿童的重要性。
Key PointsQuestionAre medical costs higher among older adults with a history of childhood maltreatment than among those without? FindingsIn this cross-sectional study of 978 adults, using national health insurance claims data in Japan, mean annual medical costs among those who experienced any childhood maltreatment were significantly higher than costs among those who did not, even after adjusting for age and sex. MeaningIn this study, childhood maltreatment was associated with additional medical costs among older adults living in Japan, which highlights the importance of primary and secondary prevention of child maltreatment.This cross-sectional study assesses whether a history of childhood maltreatment is associated with additional medical costs among older adults in Japan.ImportanceChildhood maltreatment can have significant consequences on health through the life course, but its association with health care costs in later life is not widely known. ObjectiveTo assess whether a history of childhood maltreatment is associated with additional medical costs among older adults in Japan. Design, Setting, and ParticipantsThis population-based cross-sectional study used data from the Japan Gerontological Evaluation Study, 2013, linked with national health insurance claims data from April 2012 to March 2014 for 1 municipality that participated in the Japan Gerontological Evaluation Study, 2013. The municipality had more than 1.5 million residents, and 978 independent individuals aged 65 to 75 years were included in the analysis. Data were analyzed from October 2017 to February 2019. ExposuresChildhood maltreatment, including physical abuse, emotional neglect, emotional abuse, and witnessing intimate partner violence. Main Outcomes and MeasuresMean annual medical costs between April 2012 and March 2013 and between April 2013 and March 2014. ResultsAmong 978 independent older adults (mean [SD] age, 70.6 [2.9] years; 426 [43.6%] men), 44 (4.5%) witnessed intimate partner violence, 19 (1.9%) were physically abused, 104 (10.6%) were emotionally neglected, and 56 (5.7%) were emotionally abused in childhood. In total, 176 older adults (18.0%) experienced at least 1 type of childhood maltreatment. Mean annual medical costs of those who experienced any childhood maltreatment were significantly higher than of those who did not (difference, yen136456 [US$1255]; 95% CI, yen38155-yen234757 [US$351-US$2160]; P=.007). Those who experienced emotional neglect incurred more mean medical costs than those who did not (difference, yen161400 [US$1484]; 95% CI, yen42779-yen280021 [US$394-US$2576]; P=.008). The association of any childhood maltreatment with medical costs remained significant after controlling for age and sex (average marginal effect, yen116098 [US$1068]; SE, yen53620 [US$493]; 95% CI, yen11004-yen221192 [US$101-US$2034]; P=.03). The estimated additional costs associated with childhood maltreatment would be more than yen333 billion (US$3.1 million) per year nationwide. Conclusions and RelevanceIn this study, childhood maltreatment was associated with additional medical costs among older adults living in Japan. This finding underlines the importance of primary and secondary prevention of child maltreatment.