Child Abuse Deaths Threefold Higher in Poor Communities

Diana Swift

April 24, 2017

A national analysis of deaths from child abuse by county has shown what many may have intuitively expected: A higher concentration of poverty is consistently associated with higher rates of fatalities.

"These results suggest that the economic atmosphere where a child lives may be associated with their risk of suffering a fatal abusive injury," write Caitlin A. Farrell, MD, from the Division of Emergency Medicine and the Division of General Pediatrics at Boston Children's Hospital in Massachusetts, and colleagues. Their study appeared online April 24 and in the May issue of Pediatrics.

Dr Farrell and colleagues found that US counties with the highest poverty concentration, defined as the percentage of the population living below the federally defined poverty threshold, had more than 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 [CI], 2.4 - 3.79).

The authors note that whereas individual and household poverty is an established risk factor for child maltreatment, the effect of community poverty on child abuse has been less widely studied, but is becoming better understood.

"For decades, developmental psychologists have recognized that a child's community and surrounding economic conditions are part of the macrosystem that affect a child's growth and development," they write.

Using data from the Centers for Disease Control and Prevention Compressed Mortality Files, the researchers performed a retrospective cross-sectional analysis of abuse-related deaths in US children aged 0 to 4 years between 1999 and 2014. They then calculated child abuse fatality rates for each category of community poverty levels across 5 subgroups, ranging from 0%–4.9% to 20% or more, using national population and poverty statistics from US Census data.

During the 15-year study period, 11,149 children died of child abuse, for an overall fatality rate of 3.5 per 100,000 children ages 0 to 4 years. Of the deceased, 45% were younger than 1 year, 56% were boys, and 58% were white.

By community poverty level, the fatality rate was lowest at 1.3 deaths per 100,000 children in counties with poverty concentrations below 5%. It rose with each poverty concentration level, with the highest risk for fatal abuse observed among infants living in counties with poverty concentrations of at least 20%; the fatality rate in those counties was 9.6 deaths per 100,000.

In children younger than 1 year, the child abuse fatality rate was 7.9 per 100,000. By race, the rate was 2.7 for white children (reference), 8.0 for African-American children, and 2.2 for other racial groups.

"Our results suggest that even in communities of low poverty concentration, African American children have higher rates of child abuse fatalities than white children who live in communities of high poverty concentration," Dr Farrell and coauthors write.

The authors say they hope these findings about the effect of community poverty will prompt public health officials to target resources in high-risk areas. "Community leaders, child advocates, public health officials, and health care professionals must consider community poverty when developing efforts to prevent child abuse deaths," they write.

They also note that in 2016, the American Academy of Pediatrics updated its commitment to eliminating child poverty as an adverse determinant of health and development.

In an accompanying editorial, Robert W. Block. MD, from the Department of Pediatrics at the University of Oklahoma and the Tulsa University School of Community Medicine, observed that the significant link between child abuse and fatalities comes as no surprise. "What may be surprising is that although this fact is both intuitive and now statistically proven, given the significant percentage of children living in poverty, the United States has yet to develop a comprehensive plan to address the issue," he writes.

Dr Block suggests that by acknowledging a high poverty rate in certain communities and educating community leaders to address the economic and child development challenges posed by poverty, communities might reduce the frustrating stressors of poverty that lead to child maltreatment. These include unstable housing, food insecurity, and unsafe neighborhoods.

"Although we may find ways to significantly reduce poverty, the article by Farrell et al is an important reminder of the significant consequences thrust upon an overrepresented portion of our children," he concludes.

The authors and editorialist have disclosed no relevant financial relationships.

Pediatrics. Published online April 24, 2017. Article abstract, Editorial extract

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