前言：兒童虐待對兒童身心健康有嚴重且長期之影響。由過去研究已知，受虐兒童就醫特徵有醫療使用成本高、經常更換就醫地點、特定傷害類型為兒虐的風險高等。但過去探討兒虐前就醫特徵仍有不足之處，如研究追蹤時間短、觀察就醫類別不全面或多為地區型研究。故本研究欲利用臺灣全民健康保險資料，追蹤2007年出生世代，探討受虐個案初診兒虐相關特徵、初診兒虐前一年與後一年就醫特徵及兒虐再發生狀況。本研究假說為，受虐兒童在初診兒虐前有較高的門診、急診與住院率。此外，門診初診兒虐者，後續再發生兒虐的機會大。
材料與方法：使用2007-2008年全民健保承保檔、2007-2013年全民健保門急診及住院處方及治療明細檔，追蹤2007年出生世代至五歲的就醫資料。若觀察時間內就醫診斷碼曾出現ICD-9-CM N-code 995.5x及E-code E960-E969者，則納入本研究之受虐個案。並將兒虐類型依兒虐診斷碼簡化為：心理虐待(995.51)、身體虐待(995.52, 995.54, 995.55, E961-E966)、性虐待(995.53, E960)與其他虐待(995.5, 995.50, 995.59, E967-E969)。受虐與非受虐兒童的配對方式，使用回溯性巢式個案對照研究，透過配對受虐個案年齡、配對比例1:10，選出非受虐組(觀察時間內就醫診斷無出現上述代碼者)。以描述性統計呈現受虐及非受虐兒童人口學與就醫特徵，並以卡方/精確檢定比較兩組差異，另以條件式邏輯斯迴歸計算兒虐風險。
結果與討論：2007年世代的兒童虐待診斷累積發生率為每萬人18.92。而初診兒虐類型以其他未明示虐待為最多(72.8%)，可能與本研究樣本為低齡兒童有關。過去研究顯示，身體虐待、忽略與其他虐待比例隨年齡增長而減少，精神虐待及性虐待比例則增加。而75.0%初診兒虐個案於急診發現，顯示急診為兒童虐待重要的就醫地點。條件式邏輯斯迴歸分析結果顯示，兒虐危險因子有女性(OR=1.34, 95%CI=1.08-1.67)、低收入戶(OR=3.35, 95%CI=1.71-6.57)與出生投保地中低度都市化地區(中度OR=2.01, 95%CI=1.60-2.52、低度OR=1.64, 95%CI=1.13-2.38)，與過去研究結論相似。而初診兒虐前一年曾使用1次受傷急診後續發生兒虐OR=2.39 (95%CI=1.72-3.32)、2次以上受傷急診OR=3.92 (95%CI=1.99-7.72)；使用2次以上非受傷急診OR=2.39 (95%CI=1.43-2.68)；使用1次非受傷住院OR=1.63 (95%CI=1.19-2.23)、2次以上非受傷住院OR=2.22 (95%CI=1.42-3.47)。在初診兒虐後一年內，住院初診兒虐者因傷就醫的比例高達47.4%，可能因其兒虐傷害較為嚴重，需要長時間且規律的照護資源介入。又門診初診兒虐者，再發生新的兒虐事件比例有6.7%，可能原因為門診發現兒虐嚴重程度較輕微，或門診無足夠資源可進行兒虐後續追蹤，使得這群受虐兒童容易重覆發生兒虐事件。本研究使用健保資料庫追蹤2007年世代，有低估兒虐個案之可能性。透過觀察受虐兒童初診兒虐前、中、後不同時間段，可詳細的描述兒童虐待人口學與就醫特徵，更呈現不同嚴重程度的虐待，後續再發生兒虐事件之程度。藉由本研究結果，期望增加醫事人員及早辨識疑似兒虐個案之可能性、及早介入治療與追蹤，防止受虐兒童持續處於風險環境之中。
結論：2007年出生世代的兒童虐待診斷累積發生率為每萬人中約有19人。初診兒虐類型以其他未明示虐待最多、以在急診發現為最大宗。兒虐人口學危險因子有女性、低收入戶與出生投保地中低度都市化。而首次兒虐前一年使用受傷急診1次以上、非受傷急診2次以上、非受傷住院1次以上其兒虐風險較高。在首次兒虐後一年內，住院初診兒虐者因受傷而就醫比例較高；門診初診兒虐者，再發生兒虐比例高。

The aim of this study was to examine the characteristic of children who were diagnosed as abuse case at first time, and patterns of health service utilization of abuse cases compare with the non-abuse. The study sample was 2007 birth cohort from Taiwan's National Health Insurance (NHI). Cases were defined as children who had ICD-9-CM N-code 995.5x and E-code E960-E969 diagnosis codes from their discharge data. Then we conducted a retrospective nested case-control study to compare patterns of health service utilization between case and control subjects in the year before their first abuse diagnosis. The results demonstrated that the abused diagnosis cumulative incidence rate of 2007 birth cohort was 19 per 10 thousand persons.The most abuse type of first abuse diagnosis was other abuse type, and the most cases were first diagnosed in ED settings. The risk factors of child abuse were female, low-income households, living in low urbanization area. Within one year before the first abused diagnosis, the cases were more likely to have had injury-related ED visits, non-injury-related ED visits, and non-injury-related hospital admissions. Within one year after the first abused diagnosis, the percentage of injury-related health care utilization of children who first received abused diagnosis in the hospital admission settings was high, and the percentage of recurrent child abuseof children who first received abused diagnosis in the outpatient settings was high.

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