Diverging paths: Health-care inequities by age among sexually abused children with disabilities

Abstract

Objective

This study investigated disparities in health and health-care outcomes between children with disabilities who have experienced sexual abuse and children without disabilities having such experiences, considering different stages of childhood and adolescence.

Methods

We utilized linked national datasets from Taiwan, leveraging comprehensive population-level data to analyze age-specific differences in health-care utilization. Eleven postassault health-care outcomes were analyzed, including mental health visits, pediatric and ophthalmology outpatient visits, obstetrics and gynecology care, pregnancy-related visits (3 indicators), self-harm, emergency room visits, general outpatient utilization, and total medical expenditure.

Results

Among 19,133 sexually abused children, 7.4 % had a documented disability. Children with disabilities were more likely than those without disabilities to be from low-income families. Mental health outpatient visits were significantly higher among children with disabilities, particularly at younger ages (eg, 4.53 additional visits at age 1 [P < .001]), with the effect weakening with age. By contrast, younger children with disabilities had significantly fewer general and ophthalmology outpatient visits. Disability was associated with decreased use of pregnancy-related services at older ages and had no significant effect on self-harm or emergency room visits. Total medical expenditure was higher for children with disabilities, and disparities increased with age.

Conclusion

In children with disabilities who have experienced sexual abuse, health-care utilization varies across age groups. These findings highlight a need for age-sensitive and disability-informed responses to trauma.