International journal for equity in health · 2026
Urban and rural differences in healthcare access among survivors of child sexual abuse: a nationwide survey.
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Imanishi Yousuke, Koda Masahide, Iorini Maria, Wada Ichiro, Jwa Sinchul, Tabuchi Takahiro, Uchida Mai
Аннотация
BACKGROUND: Child sexual abuse (CSA) is associated with poorer healthcare access in adulthood, but evidence remains limited on whether this association differs between urban and rural settings.
METHODS: We analyzed data from the 2023 Japan COVID-19 and Society Internet Survey (JACSIS), including 27,699 adults aged 18-79 years. Participants reported CSA before age 18 using behavior-specific items and two direct screening questions. We assessed adult healthcare access barriers, including missed scheduled visits, inability to obtain unplanned care, postponed surgery, and absence of a usual source of care. We used inverse probability of treatment weighting and weighted logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs), and we tested CSA-by-urbanicity interaction terms.
RESULTS: CSA prevalence was 9.3%. Adults with a history of CSA had higher odds of missed scheduled visits (aOR 1.76, 95% CI 1.52-2.04), inability to obtain unplanned care (aOR 2.36, 95% CI 2.00-2.78), hospitalization postponed (aOR 3.25, 95% CI 2.42-4.37), surgery postponed (aOR 4.01, 95% CI 3.05-5.29), and non-surgical treatment postponed (aOR 3.15, 95% CI 2.40-4.12). Preventive care not received did not differ significantly. CSA was also associated with higher odds of having no usual source of care (aOR 1.67, 95% CI 1.54-1.82). Urbanicity significantly modified associations for missed scheduled visits (urban: aOR 1.97, 95% CI 1.64-2.37; rural: aOR 1.44, 95% CI 1.12-1.85; p for interaction = 0.04) and preventive care not received (urban: aOR 1.01, 95% CI 0.88-1.15; rural: aOR 0.82, 95% CI 0.70-0.95; p for interaction = 0.04).
CONCLUSIONS: CSA survivors face substantial barriers to care. The stronger association with missed appointments in urban settings suggests that provider density alone does not ensure access. Trauma-informed care models may help reduce avoidance behaviors, particularly in high-volume urban practices.
METHODS: We analyzed data from the 2023 Japan COVID-19 and Society Internet Survey (JACSIS), including 27,699 adults aged 18-79 years. Participants reported CSA before age 18 using behavior-specific items and two direct screening questions. We assessed adult healthcare access barriers, including missed scheduled visits, inability to obtain unplanned care, postponed surgery, and absence of a usual source of care. We used inverse probability of treatment weighting and weighted logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs), and we tested CSA-by-urbanicity interaction terms.
RESULTS: CSA prevalence was 9.3%. Adults with a history of CSA had higher odds of missed scheduled visits (aOR 1.76, 95% CI 1.52-2.04), inability to obtain unplanned care (aOR 2.36, 95% CI 2.00-2.78), hospitalization postponed (aOR 3.25, 95% CI 2.42-4.37), surgery postponed (aOR 4.01, 95% CI 3.05-5.29), and non-surgical treatment postponed (aOR 3.15, 95% CI 2.40-4.12). Preventive care not received did not differ significantly. CSA was also associated with higher odds of having no usual source of care (aOR 1.67, 95% CI 1.54-1.82). Urbanicity significantly modified associations for missed scheduled visits (urban: aOR 1.97, 95% CI 1.64-2.37; rural: aOR 1.44, 95% CI 1.12-1.85; p for interaction = 0.04) and preventive care not received (urban: aOR 1.01, 95% CI 0.88-1.15; rural: aOR 0.82, 95% CI 0.70-0.95; p for interaction = 0.04).
CONCLUSIONS: CSA survivors face substantial barriers to care. The stronger association with missed appointments in urban settings suggests that provider density alone does not ensure access. Trauma-informed care models may help reduce avoidance behaviors, particularly in high-volume urban practices.