Urban and rural differences in healthcare access among survivors of child sexual abuse: a nationwide survey.
7 affiliations
- 1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. [email protected].
- 2Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Miyagi, Japan. [email protected].
- 3Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- 4Department of Interdisciplinary Studies, Faculty of International Liberal Arts, Dokkyo University, Saitama, Japan.
- 5Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
- 6Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- 7Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Abstract
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.
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BibTeX
@article{imanishi2026urban,
title = {{Urban and rural differences in healthcare access among survivors of child sexual abuse: a nationwide survey.}},
author = {Yousuke Imanishi and Masahide Koda and Maria Iorini and Ichiro Wada and Sinchul Jwa and Takahiro Tabuchi and Mai Uchida},
journal = {International journal for equity in health},
year = {2026},
month = jul,
doi = {10.1186/s12939-026-02957-1},
url = {https://europepmc.org/article/MED/42908022},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Urban and rural differences in healthcare access among survivors of child sexual abuse: a nationwide survey.
AU - Yousuke Imanishi
AU - Masahide Koda
AU - Maria Iorini
AU - Ichiro Wada
AU - Sinchul Jwa
AU - Takahiro Tabuchi
AU - Mai Uchida
PY - 2026
DA - 2026/07/01
JO - International journal for equity in health
DO - 10.1186/s12939-026-02957-1
UR - https://europepmc.org/article/MED/42908022
AB - 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.
SN - 1475-9276
ER -