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.

Known to health Known to justice “Universe” of Intimate Partner Violence Unknown/unreported Identified in population- based surveys

Health Indicators of Intimate Partner Violence Outpatient visits Hospitalizations Deaths Emergency department 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

Aug ‘06 Sep ‘06 Oct ‘06 Nov ‘06 Dec ‘06 Jan ‘07 IRB Approval Receive OCME numbers of female homicides from Vital Stats Data abstraction from OCME files Data entry and clean-up Preliminary analyses Round 2, OCME numbers & data abstraction Final analyses Feb ‘07 Share findings Mar ‘06 Task & Timeline: Female Homicide Surveillance

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 & victim- perpetrator 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-in- law, 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 Age-adjusted rates

Assault-Related ED Visit Rates among Women, New York City, 1999 to 2004 Age-adjusted rates

Type of Violence against Women in NYC by Injury Surveillance Data Source Average ≈100 Average ≈ 750 Average ≈ 15,650

% of cases that involved sexual violence

IPV Burden – Recent* Snapshot IPV-related female homicide ( )  37  1 death per 100,000 IPV-related Hospitalizations ( )  estimated 240  6.7 per 100,000 IPV-related ED visits ( )  estimated 3,600 ED visits  95.8 per 100,000 Self-reported fear ( )  2.6%  almost 85,000 women over 18 years old * 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, Hospitalizations,

Most fatal & non-fatal IPV occurs at home Age-adjusted proportions

Clinical manifestations of IPV CHS survey data