Patterns of Long-term Ambulatory Care Utilization Following Exposure to Physical and Non-physical Intimate Partner Violence: A Cohort Study

Intimate partner violence (IPV) is a significant determinant of womens health that can shape care needs and care-seeking over time. Evidence on long-term patterns of ambulatory care use among survivors, however, remains limited. This study examines whether exposure to physical and non-physical IPV is associated with long-term ambulatory care utilization among women in Toronto, Canada. Data come from the 2009-2011 Neighbourhood Effects on Health and Well-being (NEHW) study linked to the National Ambulatory Care Reporting System (NACRS) through 2020. IPV exposure was categorized as none, non-physical IPV only, or both physical and non-physical IPV. Negative binomial regression models estimated incidence rates per 100,000 person-years, incorporating follow-up time as an offset and adjusting for sociodemographic and health characteristics. Among participants with at least one ambulatory care visit, we also examined urgency of presentation (Canadian Triage Acuity Scale [CTAS]) and mode of arrival. Women exposed to both physical and non-physical IPV had higher rates of ambulatory care use compared with women reporting no IPV or non-physical IPV alone. For non-urgent or less urgent presentations (CTAS 4-5), incidence rates were 47.94 (95%CI: 32.75-63.13) per 100,000 person-years among women exposed to both forms of IPV, compared with 23.59 (95%CI: 17.34-29.85) among women exposed to non-physical IPV alone and 29.79 (95%CI: 25.18-34.41) among women with no IPV exposure. Differences between the "Both" group and each comparison group were statistically significant (p=0.02 and p<0.01, respectively). For urgent, emergent, or resuscitation-level visits (CTAS 3-1), incidence rates were directionally higher among women exposed to both forms of IPV (128.98; 95%CI: 101.71-156.24) versus non-physical IPV alone (98.24; 95%CI: 82.70-115.17) and no IPV (99.96; 95%CI: 90.83-108.48), though these differences were not statistically significant. These findings indicate that IPV, particularly when involving physical violence, shapes long-term patterns of ambulatory care use. Differences reflect how survivors navigate healthcare systems structured by trauma, stigma, and access constraints, underscoring the need for trauma- and violence-informed care approaches.