Trends and disparities in violence-related injury morbidity among pregnant and postpartum individuals

Abstract

PurposeViolence against pregnant and postpartum individuals is a major public health problem. Homicides during the perinatal period have recently increased, yet these deaths reflect only the most extreme manifestation of violence. Far less is known about trends and disparities in pregnancy-associated violence morbidity. Examining emergency department (ED) utilization for violence-related injuries in this population can shed light on overall incidence and patterns of risk. MethodsWe used longitudinal, all-payer, statewide data from California, comprising all individuals with a live-birth hospital delivery in each year from 2010-2018 (N = 3,068,921). We followed annual cohorts of women before and after their delivery hospitalizations to identify ED visits for violent injury. We analyzed trends and disparities in annual incidence rates. ResultsThe cumulative incidence of any pregnancy-associated ED visit for violence was 0.84% overall; incidence increased slightly over the study period (annual ORadj = 1.01, 95% CI=1.01,1.02). The highest risk of pregnancy-associated violence was observed in younger individuals, non-Hispanic Black individuals, and Medicaid users. ConclusionOur findings suggest risk of pregnancy-associated violence morbidity has increased over the past decade and is amplified for structurally vulnerable populations. The emergency department may be a critical opportunity for screening and providing resources to at-risk individuals.