Child deaths of undetermined intent: An analysis of circumstances using Illinois Violent Death Reporting System data

Characteristics of child abuse fatalities: Insights from a statewide violent death reporting system

BACKGROUND

Child maltreatment fatalities are a significant public health issue. Case level characteristics of abuse-related deaths can increase our understanding of maltreatment fatalities and inform region-specific prevention initiatives.

OBJECTIVE

Explore child abuse fatalities in the Illinois Violent Death Reporting System (IVDRS) for commonalities and distinctive features.

METHODS, PARTICIPANTS AND SETTING

A mixed methods study was conducted using IVDRS data from 2015 to 2018. All fatalities with a homicide or undetermined manner of death among decedents 10 years old or younger were included. Both discrete and narrative data were analyzed separately for victim, suspect, circumstance, and household characteristics.

RESULTS

Of the 106 deaths that met inclusion criteria, 74 % of homicide deaths (64/86) and 50 % of undetermined deaths (10/20) were due to abuse. Psychosocial characteristics most often identified in abusive deaths included family relationship problems, mental illness, and history of substance abuse. Other common characteristics included use of personal weapons or blunt instruments and death due to punishment. Including narrative data rather than discrete data alone identified 148 % more deaths with three characteristics commonly found in abusive deaths: history of abuse, shaken baby syndrome, and family history of violence.

CONCLUSION

This study demonstrates the capability of multi-source state-level data to enrich our understanding of child abuse fatalities. Employing the narrative review method in other states using the National Violent Death Reporting System may increase the identification of abuse fatalities. Improved recognition and characterization of abuse fatalities has the potential to help address systemic factors involved and enhance targeted prevention efforts.

WHAT IS KNOWN

Child abuse fatalities represent a significant and preventable public health issue in the United States. Case-specific characteristics are limited in national data sets, and their absence curtails prevention opportunities.

WHAT THIS STUDY ADDS

State-wide reporting systems of violent deaths offer rich and multisource data regarding child abuse fatalities including detailed victim, suspect, circumstance, and household characteristics. This data can be used to enhance our knowledge of maltreatment fatalities and may inform region-specific public health and prevention initiatives.

Modifiable sleep-related risk factors in infant deaths in Cook County, Illinois

Background

Each year, approximately 3500 infants in the United States die from sleep-related deaths. The number of sleep-related infant deaths has decreased overall since the 1990s, but disparities in sleep-related deaths persist among different populations. The purpose of this study was to determine the most common risk factors and locations in Cook County, Illinois for sleep-related deaths in infants under 6 months of age.

Methods

We conducted a retrospective study among infants less than 6 months of age who died in Cook County, Illinois in 2015 and 2016, in which the manner of death was of undetermined intent with at least one modifiable sleeping risk factor present, as reported by the medical examiner. Data were obtained from the Illinois Violent Death Reporting System (IVDRS), a state-based, anonymous, surveillance system. County trends and circumstances of the deaths were also evaluated. Frequencies, percentages, and Chi-square analysis were used to describe and characterize these deaths.

Results

In Cook County in 2015 and 2016, 116 infants less than 6 months of age died where the manner of death was classified as undetermined intent. The median age of death was 2 months. Of these deaths, 63 (54.3%) of the infants were boys. African-American and Hispanic infants comprised 71 (65.7%) and 23 (21.3%) of the deaths, respectively. In 84 (72.4%) of the cases, at least one known sleeping risk factor was present and 56 (66.7%) of the infants who died with a known sleeping risk factor were co-sleeping. Notably, 33 (29.7%) of the deaths in Cook County were clustered within six zip codes.

Conclusions

The majority of infants who died unexpectedly in Cook County in 2015 and 2016 did so in the presence of sleeping risk factors, with co-sleeping being the most common. African-American infants, infants under 2 months of age, and several geographical areas within Chicago appear to be at increased risk. Interventions to target these preventable causes in the populations at increased risk should be instituted to prevent future deaths.