COVID-19 and sexual assault: trends in US emergency department visits-a cross-sectional analysis

Abstract

Background: Sexual assault often increases during crises, yet trends in United States (US) emergency department (ED) visits for sexual assault during COVID-19 remain unclear.

Objective: To examine demographic, incident and injury trends in US sexual assault presentations during early and late COVID-19 compared with pre-COVID-19.

Methods: This study analysed National Electronic Injury Surveillance System All Injury Programme (2014-2021) retrospective data. ED visits for assault (n=246 499) and sexual assault (n=22 752) were compared across pre-COVID-19 (January 2014-March 2020), early COVID-19 (March 2020-January 2021) and late COVID-19 (February 2021-December 2021). Demographic and injury trends were analysed via t-tests, analysis of variance or χ² tests, with national trends assessed using Joinpoint regression and weighted data in SUDAAN.

Results: From 2017 to 2021, while assault-related ED visits declined (-5.05% annually; p=0.003), sexual assault ED visits remained stable (-1.15% annually; p=0.57). During COVID-19, sexual assault cases decreased among 0-19 years (46.1% pre-COVID-19 to 37.3% late COVID-19) but increased among 20-34 years (36.0% to 40.3%) and 35-64 years (17.2% to 21.0%). From early to late COVID-19, cases increased among black (31.7% to 32.8%) and Hispanic (13.8% to 15.6%) populations but declined among white populations (49.5% to 47.7%). Assaults by parents (9.0% to 11.2%) and partners (10.9% to 13.5%) increased, as did poisoning-related (1.4% to 5.5%) and anoxia-related injuries (0.1% to 0.7%).

Conclusions: Despite the pandemic, ED visits for sexual assault persisted, with demographic shifts and increased injury severity (eg, drug-facilitated violence, strangulation-related anoxia). These findings highlight the need for targeted interventions during public health crises.

Keywords: COVID-19; Emergencies; Sexual Health; Violence.

Figure 1. Temporal trends in ED visits for sexual assaults vs all assaults, 2014–2021. Lines represent joinpoint regression trends, with sexual assaults (dashed line) and all assaults (solid line). Significant annual changes occurred for all assaults: an increase from 2014 to 2017 (+2.51%, p=0.046) and a decrease from 2017 to 2021 (–5.05%, p=0.003). Sexual assaults increased significantly from 2014 to 2017 (+11.51%, p=0.02) but showed a non-significant decrease from 2017 to 2021 (–1.15%, p=0.57). ED, emergency department.

Figure 2. Proportions of known sexual assault-related injury diagnoses by COVID-19 era. The severity of injuries increased from pre-pandemic to post-pandemic, as indicated by the rise in anoxia and poisonings in each subsequent period. Internal organ injuries increased in early COVID-19, but returned to pre-pandemic levels in late COVID-19.

Figure 3. Anatomic locations of sexual-assault-related injuries by COVID-19 era. Compared with pre-COVID-19, there were more head and neck injuries due to sexual assault incidents during COVID-19. The lower trunk comprised the majority of locations regardless of time period.