Is There a Relationship Between Lacking a Primary Care Provider and Child Abuse?

Objective

To examine the association between lacking a primary care provider and child abuse.

Methods

We conducted a secondary data analysis of 1462 children aged ≤19 years presenting for suspected physical/sexual abuse to a child advocacy center (CAC) at an academic medical center. Children were stratified by age. The key independent variable was having a primary care provider. The dependent variable was abuse: confirmed, suspected, or ruled out. Multivariate models were adjusted for sociodemographic factors and referral source.

Results

Children aged ≤2 years without a primary care provider were more than 4 times as likely to have confirmed/suspected abuse of either type, compared with children with a provider, after adjusting for sociodemographic factors (adjusted odds ratio: 4.41; 95% confidence interval, 1.38–14.13). This relationship was also significant when looking only at children evaluated for physical abuse, but not for children evaluated for sexual abuse. Although there continued to be an association between lacking a provider and abuse, especially physical abuse, for children ≤2.5 years of age there was no association after this age. For sexual abuse, there was no association between lacking a primary care provider and sexual abuse for children of any age.

Conclusions

Among young children aged ≤2.5 years presenting to a CAC, we found an association between lacking a primary care provider and child abuse, particularly physical abuse. The significance of this association deserves further study.

Key Words: child abuse, medical home, primary care physician, primary health care