Background: Utility assessment for health outcomes experienced by victims of child maltreatment (CM) is challenging because of the age of victim, proxies (parents/caregivers) often as perpetrators, and identifying/valuing subsequent adverse health outcomes experienced in adulthood. While some evidence of the long-term health impacts of CM exists, no study has assessed the impact of CM on long-term preference-based quality of life (QoL).
Methods: Using data collected at a large HMO from adults self-reporting about adverse childhood experiences, current health status and diseases, we matched a group of adults reporting CM, defined as physical abuse (PA), sexual abuse (SA), emotional abuse (EA), physical neglect (PN) or emotional neglect (EN), to a group of adults reporting no CM. Propensity score methods were used to compare cases to controls, with the sample first divided into 5 age groups and then divided into quintiles based on propensity score within each age group (to sub-classify into 25 strata). Eleven covariates were included in the logit model to estimate propensity scores: current age, sex, race, education of mother, # of childhood residential moves, parent/caregiver owning own home, and the following childhood experiences: witnessing violence in home, substance abuse or mental illness in home, family member in prison, and parental divorce. Utilities, by maltreatment type and by age group, were imputed from the SF-36 using the SF-6D preference-based scoring algorithm.
Results: N= 2,812 cases of CM were compared to N = 3,356 controls. More than 95% of covariate imbalance was reduced using the sub-classification on the propensity score. The combined strata-level effects of any CM on SF-6D utility was a reduction of 0.028 per year (95% CI 0.022 to 0.034; p< 0.001). The impact of PA, SA, or EN alone significantly reduced utility per year, 0.015, 0.016, 0.026, respectively; while EA or PN alone did not. All utility losses for CM versus no CM by age group were significantly different: age 19–39: 0.041; age 40–49: 0.038; age 50–59: 0.023; age 60–69: 0.017; age 70+: 0.025.
Conclusions: The long-term impact of CM on adult health results in permanent and sustained loss of QoL. Including CM resulting in death and losses in childhood QoL would result in substantial reductions in quality-adjusted life expectancy for persons who are victims of CM.