Victims of sexual assault are seeking treatment in U.S. emergency rooms in growing numbers, with University of Michigan (UM) researchers detecting a 15-fold increase between 2006 and 2019.
Rapes and other forms of sexual assault occur every 68 seconds in the United States, and their number rose from 93,000 in 2006 to nearly 140,000 in 2019, according to data from the U.S. Federal Bureau of Investigation.
The increase in people seeking emergency medical care after sexual violence, however, is greater than the growth of those turning to the police for help, the study authors said.
And while there are more sexual assaults occurring, greater awareness and hospital coding changes are also contributing to the spike, the researchers noted.
"Overall destigmatization — whether that's due to the Me-Too movement or other social-political movements — have made people feel safer coming and seeking care," said lead researcher Emily Vogt, a UM medical student.
It's not clear if people who go to the ER after a sexual assault are not going to the police, Vogt added. Perhaps "they feel like that's the only place they can go," she said.
For the study, Vogt and her colleagues used data from millions of emergency department visits. They found that in 2006, more than 3,600 men and women aged 18 to 65 sought emergency care following a sexual assault. In 2019, that number jumped to nearly 55,300. (For support, contact RAINN, the Rape, Abuse and Incest National Network hotline).
Vogt's team found that those seeking ER treatment were disproportionally younger women and poorer.
However, despite the rise in ER care, hospital admissions after a sexual assault decreased by 8% — from just under 13% to 4%. Most patients (95%) were sent home, the findings showed.
Admissions may have dropped because of lack of insurance, fewer empty beds, or victims not wanting to be hospitalized due to privacy concerns, Vogt said.
Patients who were admitted tended to be poorer and have Medicaid. Victims aged 46 to 65 were also more likely to be hospitalized than younger people, possibly because the assault exacerbated other medical conditions, Vogt said.
Overall, emergency department visits increased by 23% during the same period, with sexual assault accounting for less than 1% of visits. Yet hospital charges for sexual assault visits topped $233 million in 2019, up from $6 million in 2006, the researchers reported.
ERs can do better in helping patients after a sexual assault, Vogt said. "The emergency department, even though it's a better place to go than nowhere, is probably not the best place. We need better kinds of outpatient care," she suggested.
Vogt anticipates sexual assault numbers will continue to swell. "We didn't even get to look at the years of the COVID-19 pandemic, which we already know from other studies has certainly increased rates of sexual assault," she explained.
"A lot of these patients are getting sent home, and it's unclear whether they are getting the attention they deserve," Vogt said. "We know these patients are at higher risk for [post-traumatic stress disorder], substance abuse, and psychiatric problems as a result of the trauma they've experienced."
The report was published online Oct. 20 in JAMA Network Open.
Dr. Elizabeth Miller is a professor of pediatrics at the University of Pittsburgh School of Medicine. She said sexual violence remains a significant public health concern.
"Sexual violence reporting and care-seeking is not evenly distributed across populations, and inequities persist," Miller said. "The health consequences of sexual violence remain underrecognized by our health system, especially among survivors who are marginalized because of sexism, racism, heterosexism and ableism," added Miller, co-author of an accompanying journal editorial.
Miller agreed there is both increased awareness of sexual violence and growing incidence.
"As a result of lots of community campaigns to make the experiences of sexual assault more visible, more people appear to be seeking care. But it does appear globally, we saw an increase in interpersonal violence, including childhood sexual abuse, sexual assault and intimate partner violence during the pandemic," she said.
And, she pointed out that people who are already marginalized because of gender identity, sexual minorities, females and people with disabilities experience higher incidences of sexual violence.
Miller added that survivors of sexual assault should expect to be treated with respect by law enforcement and by emergency room staff. "They should know that they can also ask for a trained sexual assault nurse examiner, and they can also ask for a victim services advocate to be present during a forensic exam," she said.
However, more is needed to improve survivor-centered care in ERs. "We need to understand how best to provide meaningful support for survivors and to not contribute to retraumatizing individuals who have experienced an assault," Miller said.
For more on sexual assault, head to the U.S. Centers for Disease Control and Prevention.
SOURCES: Emily Vogt, medical student, University of Michigan, Ann Arbor; Elizabeth Miller, MD, PhD, division director, adolescent and young adult medicine, professor, pediatrics, University of Pittsburgh School of Medicine, Penn.; JAMA Network Open, Oct. 20, 2022, online