Violence is a leading cause of death among U.S. adults under age 45. There are also 3.3 million living violence victims, most of whom forgo formal health care when injured. We developed and tested a framework to understand why. We argue that violence victims must consider their need for care and three situational factors of victimization that may serve as barriers for care seeking: the victim’s relationship to the offender, their victimization history, and the offense committed (sexual vs. nonsexual). In analyses of 9,912 violent victimizations from 8,635 participants in the National Crime Victimization Survey from 1993 to 2017, we found that injury severity and situational factors of victimization independently and interactively predict formal health care use. Even when serious injury occurs, victimizations involving known offenders, repeat victimizations, and sexual violence are less likely than their counterparts to result in formal health care use. We discuss the implications of these findings for victims and health care providers.

暴力是美国 45 岁以下成年人死亡的主要原因。还有 330 万活着的暴力受害者，其中大多数在受伤时放弃了正式的医疗保健。我们开发并测试了一个框架来理解原因。我们认为，暴力受害者必须考虑他们对护理的需求以及可能成为寻求护理障碍的三个受害情境因素：受害者与犯罪者的关系、他们的受害历史以及所犯的罪行（性与非性）。在对 1993 年至 2017 年全国犯罪受害调查的 8,635 名参与者的 9,912 次暴力受害的分析中，我们发现伤害严重程度和受害情境因素独立和交互地预测正式医疗保健的使用。即使发生严重伤害，涉及已知罪犯的受害，重复受害和性暴力导致正式医疗保健使用的可能性低于其对应者。我们讨论了这些发现对受害者和医疗保健提供者的影响。