Ethnic-specific prevalence rates of intimate partner violence against women in New Zealand.

OBJECTIVE: This study presents age-standardised ethnic-specific prevalence rates of intimate partner violence against women in New Zealand, by physical and/or sexual intimate partner violence, psychological intimate partner violence, controlling behaviours and economic abuse. METHODS: Data are from 1,431 ever-partnered women in the representative and cross-sectional He Koiora Matapopore, the 2019 New Zealand Family Violence Study. RESULTS: High lifetime prevalence of intimate partner violence is present across all ethnic groups in NZ, with over half of all women reporting any intimate partner violence (55.8%). Substantial ethnic disparities exist in intimate partner violence rates, with Maori women reporting the highest prevalence of intimate partner violence (64.6%), followed by NZ European women (61.6%). CONCLUSIONS: Intimate partner violence prevention and intervention services are needed at the population-level, and services must be culturally responsive and attuned to the needs of communities that bear the greatest burden. IMPLICATIONS FOR PUBLIC HEALTH: Ethnic differences in intimate partner violence prevalence likely contribute to health disparities at the population-level, reinforcing calls for prevention and necessitating healthcare systems to be culturally informed and mobilised to address intimate partner violence as a priority health issue.

Evidence of Gender Asymmetry in Intimate Partner Violence Experience at the Population-Level.

Claims of "gender symmetry" in intimate partner violence (IPV) prevalence are contested, with resolution of the issue complicated by methodological and measurement challenges. This study explores gendered differences in the distribution of IPV exposure at the population-level, considering multiple types of IPV exposure. The subjects comprised of 1,431 ever-partnered women and 1,355 ever-partnered men. Data from a nationally representative population-based cross-sectional survey were used to compare men and women's IPV experiences. Twenty-three IPV acts were assessed across IPV types (moderate physical, severe physical, sexual, psychological, controlling behaviors, economic). Proportions were presented by gender for the number of individual IPV acts experienced per IPV type, and the frequency of these acts (none, once, few times, or many times). A composite exposure score was developed to assess the number of acts and their frequency within types by comparing scores in tertiles and across types by correlations. Women reported greater overall prevalence of 20 of the 23 individual IPV acts assessed. Across all assessed acts, women comprised a substantially greater proportion of those who reported experiencing individual acts "many times." Women experienced more severe and more frequent IPV than men based on self-reported experience of IPV acts, and by the frequency with which acts were experienced. Significant differences between men and women's exposure scores were observed for all six assessed types, with greater proportions of women scoring in the upper tertiles. This study provides evidence of gender asymmetry in experiences of IPV at the population level. While men do experience IPV victimization, there remains need for directed and substantial resource allocation for intervention and therapeutic responses to women's exposure to IPV, and for primary prevention with men. Going forward, IPV measurement tools that consider frequency, severity, or co-occurring types of IPV are needed.

Association Between Women's Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand.

Importance: Intimate partner violence (IPV) is increasingly recognized as a contributing factor for long-term health problems; however, few studies have assessed these health outcomes using consistent and comprehensive IPV measures or representative population-based samples. Objective: To examine associations between women's lifetime IPV exposure and self-reported health outcomes. Design, Setting, and Participants: The cross-sectional, retrospective 2019 New Zealand Family Violence Study, adapted from the World Health Organization's Multi-Country Study on Violence Against Women, assessed data from 1431 ever-partnered women (63.7% of eligible women contacted) in New Zealand. The survey was conducted from March 2017 to March 2019, across 3 regions, which accounted for approximately 40% of the New Zealand population. Data analysis was performed from March to June 2022. Exposures: Exposures were lifetime IPV by types (physical [severe/any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types. Main Outcomes and Measures: Outcome measures were poor general health, recent pain or discomfort, recent pain medication use, frequent pain medication use, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition. Weighted proportions were used to describe the prevalence of IPV by sociodemographic characteristics; bivariate and multivariable logistic regressions were used for the odds of experiencing health outcomes by IPV exposure. Results: The sample comprised 1431 ever-partnered women (mean [SD] age, 52.2 [17.1] years). The sample was closely comparable with New Zealand's ethnic and area deprivation composition, although younger women were slightly underrepresented. More than half of the women (54.7%) reported any lifetime IPV exposure, of whom 58.8% experienced 2 or more IPV types. Compared with all other sociodemographic subgroups, women who reported food insecurity had the highest IPV prevalence for any IPV (69.9%) and all specific types. Exposure to any IPV and specific IPV types was significantly associated with increased likelihood of reporting adverse health outcomes. Compared with those unexposed to IPV, women who experienced any IPV were more likely to report poor general health (adjusted odds ratio [AOR], 2.02; 95% CI, 1.46-2.78), recent pain or discomfort (AOR, 1.81; 95% CI, 1.34-2.46), recent health care consultation (AOR, 1.29; 95% CI, 1.01-1.65), any diagnosed physical health condition (AOR, 1.49; 95% CI, 1.13-1.96), and any mental health condition (AOR, 2.78; 95% CI, 2.05-3.77). Findings suggested a cumulative or dose-response association because women who experienced multiple IPV types were more likely to report poorer health outcomes. Conclusions and Relevance: In this cross-sectional study of women in New Zealand, IPV exposure was prevalent and associated with an increased likelihood of experiencing adverse health. Health care systems need to be mobilized to address IPV as a priority health issue.

Association Between Men's Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand.

Importance: Health implications of intimate partner violence (IPV) against men is relatively underexplored, although substantial evidence has identified associations between IPV and long-term physical health problems for women. Given the gendered differences in IPV exposure patterns, exploration of men's IPV exposure and health outcomes using population-based samples is needed. Objective: To assess the association between men's lifetime IPV exposure and self-reported health outcomes. Design, Setting, and Participants: This cross-sectional study analyzed data from the 2019 New Zealand Family Violence Study, which was conducted across 3 regions of New Zealand. The representative sample included ever-partnered men aged 16 years or older. Data analysis was performed between May and September 2022. Exposures: Lifetime IPV against men by types (physical [severe or any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types experienced. Main Outcomes and Measures: The 7 health outcomes were poor general health, recent pain or discomfort, recent use of pain medication, frequent use of pain medication, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition. Results: The sample comprised 1355 ever-partnered men (mean [SD] age, 51.3 [16.9] years), who predominantly identified as heterosexual (96.9%; 95% CI, 95.7%-97.8%). Half of the sample (49.9%) reported experiencing any lifetime IPV, of whom 62.1% reported at least 2 types. Of all sociodemographic subgroups, unemployed men had the greatest prevalence of reporting exposure to any IPV (69.2%) and all IPV types. After adjustment for sociodemographic factors, men's exposure to any lifetime IPV was associated with an increased likelihood of reporting 4 of the 7 assessed health outcomes: poor general health (adjusted odds ratio [AOR], 1.78; 95% CI, 1.34-2.38), recent pain or discomfort (AOR, 1.65; 95% CI, 1.21-2.25), recent use of pain medication (AOR, 1.27; 95% CI, 1.00-1.62), and any diagnosed mental health condition (AOR, 1.66; 95% CI, 1.11-2.49). Specific IPV types were inconsistently associated with poor health outcomes. Any physical IPV exposure was associated with poor general health (AOR, 1.80; 95% CI, 1.33-2.43), recent pain or discomfort (AOR, 2.23; 95% CI, 1.64-3.04), and frequent use of pain medication (AOR, 1.69; 95% CI, 1.08-2.63), which appeared to be associated with exposure to severe physical IPV. Exposure to sexual IPV, controlling behaviors, and economic abuse was not associated with any assessed outcomes after sociodemographic adjustment. Experience of a higher number of IPV types did not show a clear stepwise association with number of health outcomes. Conclusions and Relevance: Results of this study indicate that exposure to IPV can adversely affect men's health but is not consistently a factor in men's poor health at the population level. These findings do not warrant routine inquiry for IPV against men in clinical settings, although appropriate care is needed if IPV against men is identified.

Lifetime Prevalence of Intimate Partner Violence and Disability: Results From a Population-Based Study in New Zealand.

INTRODUCTION: There is no population-based study on prevalence rates for all forms of intimate partner violence experienced by people with different types of disabilities in New Zealand. This study compares the reported lifetime prevalence of intimate partner violence (physical, sexual, psychological, controlling behaviors, and economic abuse) for people with different types of disabilities with that reported by those without disabilities and tests whether there is a gender difference. METHODS: From March 2017 to March 2019, a total of 2,888 women and men aged ≥16 years participated in a cross-sectional study in New Zealand using a cluster random sampling method. Face-to-face interviews were used for data collection. The WHO Multi-country Study questionnaire was employed as the data collection tool. Logistic regression was conducted, and AORs were reported. RESULTS: Those with any disability reported significantly higher rates of most forms of intimate partner violence than those without disabilities, among both genders, including physical intimate partner violence (AOR=1.80, 95% CI=1.32, 2.47 for women, AOR=2.44, 95% CI=1.72, 3.45 for men) and psychological and economic abuse. Women with disabilities were more likely to report experiences of sexual intimate partner violence than men (range =13.5-17.1% vs 4.0%-21.2% in men). Men with intellectual disability were more likely to report physical intimate partner violence than women with intellectual disability (60.5% in men and 36.0% in women). CONCLUSIONS: People with disabilities report experiencing a significantly high lifetime prevalence of intimate partner violence compared with people without disabilities. The results warrant policy and practice changes to identify early signs of abuse and intervene accordingly and warrant an investment in targeted violence prevention programs.

Prevalence of Nonpartner Physical and Sexual Violence Against People With Disabilities.

INTRODUCTION: This study aims to determine the prevalence rates of nonpartner physical and sexual violence in men and women with different disabilities compared with those in people without disabilities. METHODS: Face-to-face interviews were conducted in 3 regions of New Zealand (2017-2019), and 2,887 randomly selected respondents participated (1,464 women, 1,423 men). Respondents provided information on the disability types (physical, intellectual, psychological, none) experienced and on the experience of physical and sexual violence since age 15 years. Analysis was conducted in 2020-2021. RESULTS: More people with disabilities reported nonpartner physical and sexual violence experience than those without disabilities. For women, 15.4% of those with disabilities experienced lifetime nonpartner physical violence, and 11.1% experienced lifetime nonpartner sexual violence. For men with disabilities, 56.2% experienced lifetime nonpartner physical violence, and 5.6% experienced lifetime nonpartner sexual violence. Women and men with psychological disabilities reported the highest prevalence rates of nonpartner physical and sexual violence. The main perpetrators of nonpartner physical violence for women with disabilities were parents and relatives (59.7%), whereas for men with disabilities, strangers (59.3%) were the main perpetrators. Among people with disabilities who reported nonpartner sexual violence, 43.5% of women and 60.0% of men never sought help. CONCLUSIONS: This is one of the few studies globally reporting on the prevalence of nonpartner violence in both men and women with different disability types. It contributes information on the gender and relationships of those who perpetrated the violence. Findings highlight the need for violence prevention and intervention programs that are inclusive of and responsive to those with different disability types.

Empirical validation of the New Zealand serious non-fatal injury outcome indicator for 'all injury'.

Our purpose was to empirically validate the official New Zealand (NZ) serious non-fatal 'all injury' indicator. To that end, we aimed to investigate the assumption that cases selected by the indicator have a high probability of admission. Using NZ hospital in-patient records, we identified serious injury diagnoses, captured by the indicator, if their diagnosis-specific survival probability was ≤0.941 based on at least 100 admissions. Corresponding diagnosis-specific admission probabilities from regions in Canada, Denmark and Greece were estimated. Aggregate admission probabilities across those injury diagnoses were calculated and inference made to New Zealand. The admission probabilities were 0.82, 0.89 and 0.90 for the regions of Canada, Denmark and Greece, respectively. This work provides evidence that the threshold set for the official New Zealand serious non-fatal injury indicator for 'all injury' captures injuries with high aggregate admission probability. If so, it is valid for monitoring the incidence of serious injuries.

Towards valid 'serious non-fatal injury' indicators for international comparisons based on probability of admission estimates.

BACKGROUND: Governments wish to compare their performance in preventing serious injury. International comparisons based on hospital inpatient records are typically contaminated by variations in health services utilisation. To reduce these effects, a serious injury case definition has been proposed based on diagnoses with a high probability of inpatient admission (PrA). The aim of this paper was to identify diagnoses with estimated high PrA for selected developed countries. METHODS: The study population was injured persons of all ages who attended emergency department (ED) for their injury in regions of Canada, Denmark, Greece, Spain and the USA. International Classification of Diseases (ICD)-9 or ICD-10 4-digit/character injury diagnosis-specific ED attendance and inpatient admission counts were provided, based on a common protocol. Diagnosis-specific and region-specific PrAs with 95% CIs were calculated. RESULTS: The results confirmed that femoral fractures have high PrA across all countries studied. Strong evidence for high PrA also exists for fracture of base of skull with cerebral laceration and contusion; intracranial haemorrhage; open fracture of radius, ulna, tibia and fibula; pneumohaemothorax and injury to the liver and spleen. Slightly weaker evidence exists for cerebellar or brain stem laceration; closed fracture of the tibia and fibula; open and closed fracture of the ankle; haemothorax and injury to the heart and lung. CONCLUSIONS: Using a large study size, we identified injury diagnoses with high estimated PrAs. These diagnoses can be used as the basis for more valid international comparisons of life-threatening injury, based on hospital discharge data, for countries with well-developed healthcare and data collection systems.

Immediate and long-term outcomes of assault in pregnancy.

OBJECTIVE: We examined the immediate and long-term health outcomes of hospitalised pregnancy-related assault. METHODS: A retrospective review of hospital records was conducted using data from the New Zealand Ministry of Health's National Minimum Data Set of hospital discharges. The hospital records of pregnant women admitted to a public hospital in New Zealand between 2001 and 2006 were included in this investigation. Unique identifiers were used to identify the index pregnancy event, subsequent discharge events and mortality for five years after the index event. Discharge records were grouped as follows: pregnancy-related hospital admission, but no associated or subsequent assault recorded (pregnant only); an assault-related hospital admission event after the pregnancy, but within five years of the index pregnancy (assault after pregnancy); an assault recorded within the same hospital admission event as the pregnancy (assault during pregnancy). Generalised linear models for the binomial family were conducted to explore increased risk ratios of adverse maternal, fetal and subsequent injury outcomes depending on group assignment. RESULTS: Compared with the pregnancy-only group, the assault after pregnancy and assault during pregnancy groups had increased risk ratios for death, preterm labour, antepartum haemorrhage, infectious complication, spontaneous abortion and stillbirth. CONCLUSION: Assault during pregnancy substantially increased the risks for a number of adverse maternal and fetal outcomes. The identification of women who live in a violent relationship and the provision of adequate social support to these women may reduce the risks of subsequent injury and adverse maternal and fetal outcomes.

Identifying Maori ethnicity for estimating trends in fatal and serious non-fatal injury.

OBJECTIVES: Counts of mortality and morbidity based on routinely collected national datasets have undercounted Maori, the indigenous people of New Zealand. To correct for the undercount, when estimating fatal and serious non-fatal injury incidence, the 'ever-Maori' method has been used. This study sought to determine how well the ever-Maori method corrects for the undercount. METHODS: Trends in frequencies and age-standardised rates for fatal injury indicators were compared using: (a) ever-Maori classification; (b) New Zealand Census Mortality Study adjustment ratios applied to Total Maori counts from the Mortality Collection; and (c) Total Maori counts from the Mortality Collection. For serious non-fatal injury, trends using ever-Maori were compared with Total Maori from hospital discharge data. RESULTS: The absolute number of injuries attributable to Maori varied depending on the method used to adjust for ethnicity status, but trends over time were comparable. CONCLUSIONS AND IMPLICATIONS: At present, there is no optimal method for adjusting for the undercount of Maori in routinely collected health databases. Reassuringly, trends in fatal and serious non-fatal injury are similar across the methods of adjusting for the undercount.