67: Differences in history of domestic violence by presenting chief complaint in an outpatient urogynecology population

Abstract

Domestic violence (DV) is a common problem affecting 22-39% of US women. We aimed to determine prevalence and risk factors for domestic violence (DV) in outpatient urogynecology, specifically whether chief complaint (CC) predicts a history of DV. We included new patients from 5 urogynecologists at 7 offices from 11/2014-11/2015. A power calculation from pilot data suggested 1,000 subjects would demonstrate a difference in DV by presenting CC. DV was determined by a new patient packet question, “In your life, have you ever been sexually or physically abused?” Sociodemographic/medical data were retrospectively abstracted. Risk factors were assessed using univariable and multivariable logistic regression based on known associated variables and urogynecology specific variables not already in the medical literature. One thousand new patients had mean age 58.4 ± 15.8 with BMI 28.8 ± 6.5. Subjects were mostly white (91.9%) and married (62.4%). Half (49.7%) were sexually active, 34.8% had dyspareunia, and few reported history of abnormal pap smears (26.0%) or sexually transmitted infections (2.1%). DV prevalence was 11.9%. Pelvic Pain was the least common CC (8.6%), but most commonly reported DV (24.4%). Prolapse was the most common CC (36.2%), but had the lowest prevalence of DV (6.1%). DV was reported by 15.2% with Overactive Bladder, 14.4% with Stress Incontinence, and 11.6% with CC of "other." Patients with Pelvic Pain CC were more than twice as likely to report DV compared to all other CCs (OR = 2.690, 95% CI = 1.576-4.592). Those with pelvic pain were more likely to report DV when compared individually to prolapse (OR = 4.993, 95% CI = 2.596-9.604) and “other” (OR = 2.472, 95% CI = 1.282-4.766). There was no statistical difference compared to overactive bladder (OR = 1.798, 95% CI = 0.988-3.271) or stress urinary incontinence (OR = 1.915, 95% CI = 0.905-4.055). Multivariable regression is shown in Table 1 with 5 predictors of DV on both univariable and multivariable logistic regression. After adjustment, CC of pelvic pain was still 1.862 times as likely to report DV. Nocturia was an additional urogynecologic variable predictive of DV (OR = 1.162 per nightly episode, 95% CI = 1.033-1.308). Smoking conferred the highest likelihood of DV (OR = 3.676, 95% CI = 2.252-5.988). Domestic violence was experienced by 11.9% of outpatient urogynecology patients. This is lower than reported in the general population, potentially due to reporting bias or the older age of our patients. While those with CC of prolapse were less likely to report DV, we recommend routine screening in all women. Special efforts should be made to screen those at higher risk with CC of pelvic pain who were younger, smokers, with higher BMI, and with increased nocturia.