Objectively Evaluating Domestic Violence As Cause of Injury

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The 1992 Surgeon General’s statement on domestic violence refers to injuries treated in hospital emergency departments. That statement fostered throughout public discourse claims that domestic violence is the leading cause of injury to women. Such claims occasionally explicitly refer to hospital emergency departments. For example, Congressional documents contain the following claims:

Domestic violence is the leading cause of injury to women, accounting for nearly a third of their emergency room admissions. ^

Evidence indicates that domestic violence is the leading cause of injury to women, more common than auto accidents, muggings, and rapes by strangers combined. Indeed, it is the most frequent cause for women to seek attention at hospital emergency rooms.^

Battery is the single greatest cause of injury to women in the United States, accounting for more emergency room visits than all other injuries combined.^

At least 1380 instances of claims like “domestic violence is the leading cause of injury to women” exist in judicial opinions, Congressional documents, law journal articles, and newspaper articles published since 1987. Across instances that assert the share of women’s hospital emergency room visits caused by domestic violence, the claimed share varies from one-fifth to one-third.

Injury-Related Visits to Hospital Emergency Departments
by Cause of Injury, 1992

for U.S. persons ages 18 and older
cause rankcause of injurywomen's injury-related visitsmen's injury-related visitsdifference women / men
Source: Tabulated from NHAMCS 1992. Injury-related visits accounted for 30% and 44% of all visits to hospital emergency departments for women and men, respectively. Illnesses accounted for the remaining shares.
1Accident - falls2,785,2012,132,45231%
2Accident - motor vehicle1,598,0421,659,075-4%
3Accident - struck (ex. motor vehicle)891,4731,303,351-32%
4Accident - cut or pierced782,3861,479,544-47%
5Overexertion565,780754,580-25%
6Violence489,944780,524-37%
7Accident - other468,280822,696-43%
8Accident - natural and environmental419,851408,0653%
9Drugs (medical) and medical procedures387,324255,83451%
10Accident - fire, flames, submers204,465231,971-12%
11Accidental poisoning178,512190,848-6%
12Accident - machinery131,490315,996-58%
13Self-inflicted63,77954,62117%
14Law enforcement and war11,08741,664-73%
Cause not specified (inc. just place of occurrence)1,543,2042,316,915-33%
Total10,520,81812,748,136-17%

Evaluated reasonably with respect to objective, credible data, claims that domestic violence is the leading cause of injury to women greatly exaggerate the extent of domestic violence against women. The U.S. National Hospital Ambulatory Medical Care Survey (NHAMCS) provides nationally representative data on causes of visits to hospital emergency departments yearly since 1992. Tabulating 1992 NHAMCS data by causes grouped informatively and reasonably indicates that violence, which encompasses domestic violence and other violence, is the sixth largest cause of injury to women ages 18 and older. Compared to men, women suffer 37% fewer injury-related emergency visits from violence. Results are similar for women ages 15 to 44, although, across those ages, women suffer 12% fewer accidental falls than do men. Motor vehicle accidents and accidental falls account for far higher shares of injuries to women than does violence.

From the early 1990s, one could credible know that domestic violence accounts for about 1% of all women’s visits to hospital emergency departments. Persons seek attention at hospital emergency departments for both illnesses and injuries. NHAMCS data from 1992-1995 indicate that 30% of women’s hospital emergency department visits are due to injury. Of those visits due to injury, about 5% were due to violent injury. Of those visits due to violent injury, about 60% were due to domestic violence. Thus domestic violence against women accounted for about 1% (60% times 5% times 30%) of women’s visits to hospital emergency departments. That’s far less than claims that domestic violence accounts for one-fifth to one-third of women’s hospital emergency department visits.

Another objective, credible, nationally representative injury survey similarly indicates sensational overstatement of injuries from domestic violence against women. The U.S. National Electronic Injury Surveillance System All Injury Program (NEISS AIP) generated its first full-year of injury data in 2001. The NEISS is administered separately from the NHAMCS and differs in some technical respects from the NHAMCS. NEISS data on causes of injury similarly show that violence, which encompasses domestic violence and other violence, is the sixth largest cause of injury to women. Motor vehicle accidents and accidental falls account for far higher shares of injuries to women than does violence. Women suffer about a third fewer injuries from violence than men do. Domestic violence is far from the leading cause of injury to women.

Injury-Related Visits to Hospital Emergency Departments
by Cause of Injury, 2010

for U.S. persons ages 18 and older
cause rankCause of Injurywomen's injury-related visitsmen's injury-related visitsdifference women / men
Source: NEISS AIP, via WISQARS. Listing of top-20 cause of injury for women and men, respectively. Blank data cells indicate a cause of injury in women's top-20, but not men's, or vice versa.
1Unintentional Fall3,001,9362,061,44146%
2Unintentional MV-Occupant1,371,4931,176,19217%
3Unintentional Overexertion1,264,7741,505,984-16%
4Unintentional Struck By/Against1,021,5861,675,490-39%
5Unintentional Cut/Pierce672,2381,232,192-45%
6Other Assault -- Struck By/Against418,860625,909-33%
7Unintentional Other Bite/Sting285,900243,34017%
8Unintentional Unknown/Unspecified193,374314,201-38%
9Unintentional Other Transport180,517223,465-19%
10Unintentional Fire/Burn160,314183,544-13%
11Unintentional Foreign Body150,300308,958-51%
12Unintentional Poisoning148,087231,037-36%
13Unintentional Other Specified140,195232,514-40%
14Self-harm Poisoning104,51376,24537%
15Unintentional Dog Bite92,626102,018-9%
16Unintentional Pedestrian49,65061,730-20%
17Unintentional Pedal Cyclist47,119144,633-67%
18Unintentional Machinery42,469245,657-83%
19Other Assault -- Cut/Pierce28,40388,477
20Sexual Assault All Injury Causes27,575
20Unintentional Motorcyclist142,308
total injury-related visits9,553,32111,123,451-14%
total violence (ex. self-harm and legal intervention)538,727807,375-33%

The claim that domestic violence is the leading cause of injury to women persists for a variety of reasons. Unreasonable, misleading, or incredible statements can be made to support it. Publications of NHAMCS summary statistics have largely avoided publishing directly relevant statistics on causes of injury. NEISS data on leading causes of nonfatal injury have been readily and publicly available through the Web-based Injury Statistics Query and Reporting System(WISQARS). Nonetheless, persons publicly discussing domestic violence against women have been largely uninterested in learning from the best available statistics on causes of injuries. Structural biases of public discourse favor preferential concern for women and criminal suspicion of men.

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