Caitlin A Farrell1,2, Eric W Fleegler3,2, Michael C Monuteaux3,2, Celeste R Wilson2,4, Cindy W Christian5,6, Lois K Lee3,2. 1. Divisions of Emergency Medicine and caitlin.farrell@childrens.harvard.edu. 2. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. 3. Divisions of Emergency Medicine and. 4. General Pediatrics, Boston Children's Hospital, Boston, Massachusetts. 5. Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and. 6. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND AND OBJECTIVE: Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. METHODS: This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities. RESULTS: From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were <1 year old, 56% (6283) were boys, and 58% (6480) were white. The overall rate of fatal child abuse was 3.5 per 100 000 children 0 to 4 years old. In the multivariate model, counties with the highest poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). CONCLUSIONS: Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources.
BACKGROUND AND OBJECTIVE:Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to childabuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. METHODS: This was a retrospective, cross-sectional analysis of childabuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and childabuse fatalities. RESULTS: From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were <1 year old, 56% (6283) were boys, and 58% (6480) were white. The overall rate of fatal child abuse was 3.5 per 100 000 children 0 to 4 years old. In the multivariate model, counties with the highest poverty concentration had >3 times the rate of childabuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). CONCLUSIONS: Higher county poverty concentration is associated with increased rates of childabuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources.
Authors: Jennifer A Hoffmann; Caitlin A Farrell; Michael C Monuteaux; Eric W Fleegler; Lois K Lee Journal: JAMA Pediatr Date: 2020-03-01 Impact factor: 16.193
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