VCOM Carolinas Research Day 2023

Clinical Studies

Effect of Covid-19 on Reports of Domestic Violence in the Clinical Setting

Abstract # CLIN-1

Brittany Davis OMS IV, Alexis Stoner, PhD MPH, David Redden, PhD . Edward Via College of Osteopathic Medicine – Carolinas and Auburn




Introduction or Methods Domestic Violence continues to be an ongoing public health battle that affects not only millions of Americans each year, but also those all over the world. Due to the stay-at-home orders and quarantine in place from 2020 to early 2021 as a result of the Coronavirus-2019 pandemic, we have seen an increase in domestic violence related issues. During the time of the lockdown, one study found that San Antonio, TX alone reported an 18% increase in calls pertaining to family violence and 27% increase in Domestic Violence calls during March 2020 compared to March 2019. 1 Objective: To determine whether there was an increase in reports of patients presenting to medical facilities with domestic violence related complaints as recorded by 3 rd and 4 th year medical students in the clinical setting from pre pandemic to levels during the pandemic. • Using the CREDO reporting system developed at Edward Via College of Osteopathic Medicine, we analyzed the reported sum of 7 domestic violence related cases by ICD-10 code (International Classification of Disease Code, 10 th revision) classified as before March 2020 and after March of 2020, these are seen in table 1 • All races, sexes, and ages were included in this study and no patient identifiers were used in the documentation process. • The sum and percent increase of each ICD-10 Code was calculated using the total amount of data for all ICD-10 Codes on CREDO for before March 2020 and after March 2020. • Event rates of Domestic Violence Codes between time periods were compared using Poisson Regression Modeling. From the Poisson Regression, risk ratios and their 95% confidence intervals were calculated. P-value of .05 was used T74: adult and child abuse, neglect and other maltreatment, confirmed T74.11: Adult physical abuse, confirmed T74.2: Sexual abuse, confirmed T74.22: Child sexual abuse, confirmed Z69.11: Encounter for mental health services for victim of spousal or partner abuse Z91.410: Personal history of adult physical and sexual abuse Z91.411: Personal history of adult psychological abuse Table 1 . ICD-10 Codes Analyzed.

• Overall, there was a statistically significant increase in the rates of reporting of these domestic violence cases presenting in health care settings. • This data correlates with the other types of reporting domestic violence such as increases in domestic violence related police calls and usage of domestic violence hot lines 1 . • By recognizing situations like pandemics in which populations may be at increased risk for certain issues such as domestic violence, discovering trends may help further the awareness and allow providers to provide better care for their patients. • The results of this study rely on student reporting of clinical encounters. This is subject to error and the accidental omission of some encounters or the incorrect ICD-10 codes entered for an encounter which could lead to a slight overestimation or underestimation of the actual patients seen in the clinic. • One future study could be further analysis of areas with higher incidence of Domestic Violence reporting compares to areas of lower incidences as seen below.

• Analysis of the ICD-10 Codes revealed a 214.7% increase in all 7 of the Domestic Violence Related ICD-10 Codes reported since March 2020 and the onset of Covid-19 Pandemic • Cases were present among all age groups and both males and females as seen in table 3 • There was an increased risk of reporting 5 out of 7 ICD-10 codes related to domestic violence after March compared to prior March 2020 with p-values less than .05 as seen in table 2 • The ICD-10 codes with the largest number of cases were Child Sexual abuse, confirmed and Personal history of adult physical or sexual abuse. • The ICD -10 codes with the biggest increase in cases reported were ICD-10 code Child Sexual abuse, with a 675.5% jump, from 40 cases to 303 cases and ICD-10 code Sexual abuse, confirmed with an increase from 13 cases to 63 cases, a 384.6% increase.

Table 2 ICD-10 Codes and the Risk Ratio and Confidence Interval

ICD 10 Code

Risk Ratio 95% CI



4.03 (2.22,7.33)



0.93 (0.49,1.75)



1.9 (1.32,2.73)


Figure 1. This image displays a map of the areas from which the data was collected, the darker areas demonstrate the areas with higher incidences of Domestic Violence Reporting


6.31 (4.54,8.77)



9.99 (1.30,76.84) 0.027

Z91.410 1.32 (1.01,1.72)


Z91.411 2.5 (0.81,7.74)


Table 3 . Totals of ICD-10 Codes Categorized by gender and age


ICD 10 Code

total before March 2020

after March 2020

male female infant 1 14

14 18

19 44


65 84



T74 76 13 63 35 41 21 29 9 10 4 3 T74.11 37 18 20 7 30 17 10 10 T74.2 138 42 96 22 116 11 29 78 16 4 T74.2 2 343 40 303 49 294 3 215 104 17 Z69.11 13 1 12 1 12 6 7


Z91.4 10 Z91.4 11

222 86 136 17 205

2 151 51 18 1

16 1 9 5 2 Total 845 204 642 136 710 24 255 145 288 93 37 1 4 12 5 12

Dr. Skip Garner, PhD for assistance with access to the data and assistance on CREDO system Cameron Sumpter, for assistance with CREDO data access and analysis.


2 0 2 3 R e s e a r c h R e c o g n i t i o n D a y

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