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. 2023 Jan;8(3-4):80-89.
doi: 10.1159/000527363. Epub 2022 Oct 7.

Sex Differences in Health Conditions Associated with Sexual Assault in a Large Hospital Population

Allison M Lake  1   2 , Slavina B Goleva  3 , Lauren R Samuels  4 , Laura M Carpenter  5 , Lea K Davis  1   2   6   7
Affiliations

Sex Differences in Health Conditions Associated with Sexual Assault in a Large Hospital Population

Allison M Lake et al. Complex Psychiatry. 2023 Jan.

Abstract

Introduction: Sexual assault is an urgent public health concern with both immediate and long-lasting health consequences, affecting 44% of women and 25% of men during their lifetimes. Large studies are needed to understand the unique healthcare needs of this patient population.

Methods: We mined clinical notes to identify patients with a history of sexual assault in the electronic health record (EHR) at Vanderbilt University Medical Center (VUMC), a large university hospital in the Southeastern USA, from 1989 to 2021 (N = 3,376,424). Using a phenome-wide case-control study, we identified diagnoses co-occurring with disclosures of sexual assault. We performed interaction tests to examine whether sex modified any of these associations. Association analyses were restricted to a subset of patients receiving regular care at VUMC (N = 833,185).

Results: The phenotyping approach identified 14,496 individuals (0.43%) across the VUMC-EHR with documentation of sexual assault and achieved a positive predictive value of 93.0% (95% confidence interval = 85.6-97.0%), determined by manual patient chart review. Out of 1,703 clinical diagnoses tested across all subgroup analyses, 465 were associated with sexual assault. Sex-by-trauma interaction analysis revealed 55 sex-differential associations and demonstrated increased odds of psychiatric diagnoses in male survivors.

Discussion: This case-control study identified associations between disclosures of sexual assault and hundreds of health conditions, many of which demonstrated sex-differential effects. The findings of this study suggest that patients who have experienced sexual assault are at risk for developing wide-ranging medical and psychiatric comorbidities and that male survivors may be particularly vulnerable to developing mental illness.

Keywords: Clinical informatics; Electronic health records; Sex differences; Women's health.

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Conflict of interest statement

The authors have declared no conflicts of interest.

Figures

Fig. 1
Fig. 1
Psychiatric phenotypic associations with sexual assault. Log10-scale forest plots displaying ORs with 95% CI for adjusted associations between sexual assault and all tested psychiatric phecodes in sex-combined analyses. Associations achieving statistical significance are colored green. Related phecodes are grouped together (for example, the “Antisocial/borderline personality DO” phecode [301.2] is related to its parent phecode “Personality DOs” [301]). Red dashed line indicates an OR of 1. DO, disorder.
Fig. 2
Fig. 2
Nonpsychiatric associations with sexual assault. PheWAS plot from sex-combined analysis displaying −log10(p value) for all nonpsychiatric phecodes analyzed. Dashed red line indicates significance threshold (Bonferroni-corrected p < 0.05).
Fig. 3
Fig. 3
History of sexual assault increases odds of clinical phenotypes in a sex-differential manner. For each of the 55 phenotypes with significant sexual-assault-by-sex interaction effects, log10-scale odds ratio (OR) and 95% CI is plotted separately by sex for nonpsychiatric phecodes (left) and psychiatric phecodes (right). The ORs correspond to the sex-stratified associations between sexual assault and each phenotype. Associations are grouped by related phenotypes. Red dashed line indicates an OR of 1. DO, disorder.
See this image and copyright information in PMC

References

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