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Smith JN, Guttmann A, Kopp A, Vandermorris A, Shouldice M, Harron KL. Association of maternal risk factors with infant maltreatment: an administrative data cohort study. Arch Dis Child 2023; 109:23-29. [PMID: 37758290 DOI: 10.1136/archdischild-2022-325239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We aimed to evaluate the risk of infant maltreatment associated with commonly used criteria for home visiting programmes: young maternal age, maternal adversity (homelessness, substance abuse, intimate partner violence), newcomer status and mental health concerns in Ontario, Canada. DESIGN This retrospective cohort study included infants born in hospital in Ontario from 1 April 2005 to 31 March 2017 captured in linked health administrative and demographic databases. Infants were followed from newborn hospitalisation until 1 year of age for child maltreatment captured in healthcare or death records. The association between type and number of maternal risk factors, and maltreatment, was analysed using multivariable logistic regression modelling, controlling for infant characteristics and material deprivation. Further modelling explored the association of each year of maternal age with maltreatment. RESULTS Of 989 586 infants, 434 (0.04%) had recorded maltreatment. Maternal age <22 years conferred higher risk of infant maltreatment (adjusted OR (aOR) 5.5, 95% CI 4.5 to 6.8) compared with age ≥22 years. Maternal mental health diagnoses (aOR 2.0, 95% CI 1.6 to 2.5) were also associated with maltreatment, while refugee status appeared protective (aOR 0.6, 95% CI 0.4 to 1.0). The odds of maltreatment increased with higher numbers of maternal risk factors. Maternal age was associated with maltreatment until age 28 years. CONCLUSION Infants born to young mothers are at greater risk of infant maltreatment, and this association remained until age 28 years. These findings are important for ensuring public health interventions are supporting populations experiencing structural vulnerabilities with the aim of preventing maltreatment.
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Affiliation(s)
- Jennifer N Smith
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
| | - Astrid Guttmann
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Ashley Vandermorris
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Shouldice
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katie L Harron
- The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
- ICES, Toronto, Ontario, Canada
- UCL Great Ormond Street Institute of Child Health, London, UK
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Chen HH, Wang IA, Hsieh TW, Tsay JH, Chen CY. Early predictors for maltreatment-related injuries in infancy and long-term mortality: a population-based study. BMC Public Health 2023; 23:2232. [PMID: 37957616 PMCID: PMC10641954 DOI: 10.1186/s12889-023-17180-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Incidence, health consequences, and social burden associated with child maltreatment appeared to be borne disproportionately by very young children. We conducted a population-based data linkage study to explore child- and family-level factors that affect receiving different diagnoses of maltreatment injuries and investigate excessive mortality throughout toddlerhood. METHODS We conducted a retrospective cohort study comprising 2.2 million infants born in 2004-2014 in Taiwan. Incident cases of child maltreatment were defined by hospitalization or emergency department visits for three heterogeneous diagnostic groups of maltreatment-related injuries (i.e., maltreatment syndrome, assaults, and undetermined causes) within 12 months after birth. The generalized linear model and landmark survival analyses were used to evaluate risk factors. RESULTS An estimated 2.9‰ of infants experienced at least one maltreatment-related injury, with a three-year mortality rate of 1.3%. Low birthweight was associated with increased risk of receiving the diagnosis of three maltreatment injuries, particularly maltreatment syndrome (adjusted Incidence Rate Ratio [aIRR] = 4.08, 95% confidence interval [CI]: 2.93-5.68). Socially advantaged family condition was inversely linked with receiving the diagnosis of maltreatment syndrome and assaults (e.g., high income: aIRR = 0.55 and 0.47), yet positively linked with undetermined cause (aIRR = 2.05, 95% CI: 1.89-2.23). For infants exposed to maltreatment, low birth weight and non-attendance of postnatal care were highly predictive of fatality; low birthweight served as a vital predictor for premature death during toddlerhood (aIRR = 6.17, 95% CI: 2.36-15.4). CONCLUSIONS Raising awareness of maltreatment-related injuries in infancy and predictors should be a priority for appropriate follow-up assessment and timely intervention.
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Affiliation(s)
- Hsin-Hung Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan
- Division of Pediatric Neurosurgery, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-An Wang
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Tan-Wen Hsieh
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Jen-Huoy Tsay
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
- Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
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Lewis KN, Tilford JM, Goudie A, Beavers J, Casey PH, McKelvey LM. Cost-benefit analysis of home visiting to reduce infant mortality among preterm infants. J Pediatr Nurs 2023:S0882-5963(23)00111-2. [PMID: 37183165 DOI: 10.1016/j.pedn.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The Following Baby Back Home (FBBH) visiting program, which is provided by nurse and social worker teams, supports families of low-birthweight preterm infants after discharge from a neonatal intensive care unit. Enrollment in the FBBH program has been documented to reduce the likelihood of infant death. In this study, we conducted a cost-benefit analysis of the FBBH program. DESIGN AND METHODS Infants enrolled in the FBBH program (N = 416) were identified through administrative records. Infants in the FBBH program were propensity score matched with comparison infants to estimate the difference in healthcare costs in the first year of life. RESULTS Infants enrolled in the FBBH program incurred similar medical care costs compared to a comparison group. Avoided deaths, program costs, healthcare costs resulted in net economic benefits of the FBBH program to avoid infant death estimate at $83,020, cost per life saved at $3080, and benefit-to-cost ratio at 27.95. CONCLUSIONS The FBBH program's net economic benefits from avoided deaths suggest a substantial return on investment of resources, yielding benefits in excess of program and healthcare costs. PRACTICE IMPLICATIONS It is economically beneficial to provide home visiting services to families of low-birthweight babies by a team comprised of a registered nurse and social worker.
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Affiliation(s)
- Kanna N Lewis
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - J Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Anthony Goudie
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Arkansas Center for Health Improvement, Little Rock, AR, United States of America
| | - Jared Beavers
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Patrick H Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lorraine M McKelvey
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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Sullivan KS, Richardson S, Ross A, Cederbaum JA, Pflieger J, Abramovitz L, Bukowinski A, Stander V. Pre- and Perinatal Risk Factors for Child Maltreatment in Military Families Across the First Two Years of Life. CHILD MALTREATMENT 2023; 28:209-220. [PMID: 35427204 DOI: 10.1177/10775595221088198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families.
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Affiliation(s)
| | - Sabrina Richardson
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Abigail Ross
- Graduate School of Social Service, 5923Fordham University, New York, NY, USA
| | - Julie A Cederbaum
- Suzanne Dworak-Peck School of Social Work, 5116University of Southern California, Los Angeles, CA, USA
| | - Jacqueline Pflieger
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Lisa Abramovitz
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Anna Bukowinski
- Leidos, Inc., San Diego, CA, USA
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
| | - Valerie Stander
- Center for Deployment Health Research, 115252Naval Health Research Center, San Diego, CA, USA
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Ziobrowski HN, Buka SL, Austin SB, Duncan AE, Sullivan AJ, Horton NJ, Field AE. Child and Adolescent Abuse Patterns and Incident Obesity Risk in Young Adulthood. Am J Prev Med 2022; 63:809-817. [PMID: 35941047 DOI: 10.1016/j.amepre.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/12/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Child abuse is associated with adult obesity. Yet, it is unknown how the developmental timing and combination of abuse types affect this risk. This report examined how distinct child and adolescent abuse patterns were associated with incident obesity in young adulthood. METHODS Data came from 7,273 participants in the Growing Up Today Study, a prospective cohort study in the U.S. with 14 waves from 1996 to 2016 (data were analyzed during 2020-2021). An abuse group variable was empirically derived using latent class analysis with indicators for child (before age 11 years) and adolescent (ages 11-17 years) physical, sexual, and emotional abuse. Risk ratios for obesity developing during ages 18-30 years were estimated using modified Poisson models. Associations of abuse groups with BMI across ages 18-30 years were then examined using mixed-effects models. All models were stratified by sex. RESULTS Among women, groups characterized by abuse had higher BMIs entering young adulthood and greater changes in BMI per year across young adulthood. Groups characterized by multiple abuse types and abuse sustained across childhood and adolescence had approximately twice the risk of obesity as that of women in a no/low abuse group. Associations were substantially weaker among men, and only a group characterized by physical and emotional abuse in childhood and adolescence had an elevated obesity risk (risk ratio=1.38; 95% CI=1.04, 1.83). CONCLUSIONS Obesity risk in young adulthood varied by distinct abuse groups for women and less strongly for men. Women who experience complex abuse patterns have the greatest risk of developing obesity in young adulthood.
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Affiliation(s)
- Hannah N Ziobrowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
| | - Stephen L Buka
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexis E Duncan
- Brown School, Washington University in St. Louis, St. Louis, Missouri; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | | | - Nicholas J Horton
- Department of Mathematics & Statistics, Amherst College, Amherst, Massachusetts
| | - Alison E Field
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Shackshaft T, Junaid F, Badrinath P. Making every contact count: Can healthcare professionals do more to avoid preventable child deaths? CHILD ABUSE & NEGLECT 2022; 132:105825. [PMID: 35932657 DOI: 10.1016/j.chiabu.2022.105825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Healthcare professionals (HCPs) have a responsibility and unique opportunities to identify and act on safeguarding concerns. Child Safeguarding Practice Reviews (CSPRs) are produced in the United Kingdom when a child has died or been seriously harmed, and abuse or neglect is suspected or confirmed. To our knowledge there is no recent systematic analysis of CSPRs from an HCP perspective. OBJECTIVE To establish if HCPs are acting in an appropriate and safe manner when confronted with cases of potential child abuse and neglect and recommend areas for further improvement. PARTICIPANTS AND SETTINGS CSPR abstracts published on a specialist UK database between 2018 and 2021 involving the death of a child. METHODS After applying the exclusion criteria we used stratified random sampling to select one third of eligible reports. Using a systematic framework, common qualitative themes were extracted and analyzed. RESULTS 42 of 125 eligible CSPRs were analyzed. Child deaths were more common in male children and those aged under one. We identified areas where communication could be further improved including better understanding of the referral process, coordination at discharge, and communication between primary and secondary care. We found that HCPs were not well equipped to identify risk factors for child abuse such as poor parental health and complex family structures. CONCLUSIONS There is significant scope for improvement in strengthening the knowledge and skill base of HCPs in identifying and acting on signs of child abuse. We propose improvements in terms of staff training, resources and better systems to ensure HCPs respond to safeguarding concerns safely and appropriately.
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Affiliation(s)
- Thomas Shackshaft
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich IP1 2BX, United Kingdom
| | - Fatima Junaid
- Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, United Kingdom.
| | - Padmanabhan Badrinath
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich IP1 2BX, United Kingdom.
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Rebbe R, Mienko JA, Martinson ML. Reports and Removals of Child Maltreatment-Related Hospitalizations: A Population-Based Study. CHILD MALTREATMENT 2022; 27:235-245. [PMID: 33375836 PMCID: PMC11326083 DOI: 10.1177/1077559520984549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite U.S. child protective services (CPS) agencies relying on mandated reporters to refer concerns of child maltreatment to them, there is little data regarding which children mandated reporters decide to report and not to report. This study addresses this gap by utilizing a population-based linked administrative dataset to identify which children who are hospitalized for maltreatment-related reasons are reported to CPS and which are removed by CPS. The dataset was comprised of all children born in Washington State between 1999 and 2013 (N = 1,271,416), all hospitalizations for children under the age of three, and all CPS records. We identified maltreatment-related hospitalizations using standardized diagnostic codes. We examined the records for children with maltreatment-related hospitalizations to identify hospitalization-related CPS reports and if the child was removed from their parents. We tested for differences in these system responses using multinomial regression. About two-thirds of children identified as experiencing a child maltreatment-related hospitalization were not reported to CPS. We found differences in responses by maltreatment subtype and the type of diagnostic code. Children whose hospitalizations were related to abuse and associated with a specific maltreatment code had increased odds of being both reported to CPS and subsequently removed by CPS.
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Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Joseph A Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, Seattle, WA, USA
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Rebbe R, Martinson ML, Mienko JA. The Incidence of Child Maltreatment Resulting in Hospitalizations for Children Under Age 3 Years. J Pediatr 2021; 228:228-234. [PMID: 32822739 PMCID: PMC7752851 DOI: 10.1016/j.jpeds.2020.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the incidence of child maltreatment-related hospitalizations for children under 3 years for the population of Washington State. STUDY DESIGN A population-based study using retrospective linked administrative data for all children born in Washington State from 2000 through 2013 (n = 1 191 802). The dataset was composed of linked birth and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using diagnostic codes, both specifically attributed to and suggestive of maltreatment. Incidence were calculated for the population, by birth year, by sex, and by maltreatment subtype. RESULTS A total of 3885 hospitalizations related to child maltreatment were identified for an incidence of 10.87 per 10 000 person-years. Hospitalizations related to child maltreatment accounted for 2.1% of all hospitalizations for children under the age of 3 years. This percentage doubled over time, reaching a high in 2012 (3.6%). More than one-half of all hospitalizations were related to neglect. Maltreatment-related hospitalizations occurred most frequently in the first year of life for all subtypes except for neglect, which occurred the most between 1 and 2 years of age. Male children had higher incidence than female children in general (11.97 vs 9.70 per 10 000 person-years) and across all subtypes. CONCLUSIONS Hospitalizations can be a useful source of population-based child maltreatment surveillance. The identification of neglect-related hospitalizations, likely the result of supervisory neglect, because the most common subtype is an important finding for the development of prevention programming.
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Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA.
| | | | - Joseph A Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington
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Rebbe R, Bishop AS, Ahn J, Mienko JA. Opioid overdose events and child maltreatment indicators: Differential county-level associations. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105671. [PMID: 33384462 PMCID: PMC7771646 DOI: 10.1016/j.childyouth.2020.105671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles CA USA 90015
| | - Asia S. Bishop
- School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Jooree Ahn
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Joseph A. Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
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Kenny KS, Pulver A, O'Campo P, Guttmann A, Urquia ML. Do socioeconomic and birth order gradients in child maltreatment differ by immigrant status? J Epidemiol Community Health 2020; 75:22-28. [PMID: 32938615 PMCID: PMC7788479 DOI: 10.1136/jech-2019-212759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/29/2020] [Indexed: 11/25/2022]
Abstract
Background While literature has documented strong gradients in child maltreatment (CM) by socioeconomic status and family composition in the general population, how these patterns extend to immigrants remain inconclusive. Using population-based administrative data, we examined, for the first time, whether gradients in CM by neighbourhood income and childbirth order vary by immigrant status. Methods We used linked hospitalisation, emergency department visits, small-area income, birth and death records with an official Canadian immigration database to create a retrospective cohort of all 1 240 874 children born from 2002 to 2012 in Ontario, Canada, followed from 0 to 5 years. We estimated rate ratios of CM among immigrants and non-immigrants using modified Poisson regression. Results CM rates were 1.6 per 100 children among non-immigrants and 1.0 among immigrants. CM was positively associated with neighbourhood deprivation. The adjusted rate ratio (ARR) of CM in the lowest neighbourhood income quintile versus the highest quintile was 1.57 (95% CI 1.49 to 1.66) for non-immigrants and 1.33 (95% CI 1.15 to 1.54) for immigrants. The socioeconomic gradient disappeared when restricted to children of immigrant mothers arrived at 25+ years and in analyses excluding emergency department visits. Compared to a first child, the ARR of CM for a fourth or higher-order child was 1.75 (95% CI 1.63 to 1.89) among non-immigrants and 0.57 (95% CI 0.44 to 0.74) among immigrants. Conclusions Immigrants exhibited lower CM rates than non-immigrants across neighbourhood income quintiles and differences were greatest in more deprived neighbourhoods. The contrasting birth order gradients between immigrants and non-immigrants require further investigation.
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Affiliation(s)
- Kathleen S Kenny
- Department of Community Health Sciences, Max Rady College of Medicinea, University of Manitoba, Winnipeg, Canada
| | - Ariel Pulver
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St.Michael's Hospital, Toronto, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marcelo L Urquia
- Department of Community Health Sciences, Max Rady College of Medicinea, University of Manitoba, Winnipeg, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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Rebbe R, Mienko JA, Martinson ML. Incidence and Risk Factors for Abusive Head Trauma: A Population-Based Study. CHILD ABUSE REVIEW (CHICHESTER, ENGLAND : 1992) 2020; 29:195-207. [PMID: 33071539 PMCID: PMC7567009 DOI: 10.1002/car.2630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
Previous studies on Abusive Head Trauma (AHT) suggest incidence may vary by geographic location and there is limited information regarding population-based risk factors on this form of child maltreatment. This study provides new knowledge regarding these two aspects using the population of the US state of Washington born between 1999 and 2013. We used a linked administrative dataset comprised of birth, hospital discharge, child protective services (CPS) and death records to identify the scale and risk factors for AHT for the state population using quantitative survival methods. We identified AHT using diagnostic codes in hospital discharge records defined by the US Centers for Disease Control. A total of 354 AHT hospitalisations were identified and the incidence for the state was 22.8 per 100 000 children under the age of one. Over 11 per cent of these children died. Risk factors included a teenaged mother at the time of birth, births paid for using public insurance, child's low birth weight, and maternal Native American race. The strongest risk factor was a prior CPS allegation, a similar finding to a California study on injury mortality. The practice and policy implications of these findings are discussed.
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Affiliation(s)
- Rebecca Rebbe
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA, USA
| | - Joseph A Mienko
- Center for Social Sector Analytics & Technology, University of Washington School of Social Work, Seattle, WA, USA
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