Official Title: Local macroeconomic trends and hospital admissions for child abuse, 2000 to 2009
Research Lead: Joanne N. Wood
Study Team: Sheyla P. Medina, Chris Feudtner, Xianqun Luan, Russell Localio, Evan S. Fieldston, David M. Rubin
Sponsored By: PolicyLab
Dates: August 2010 – December 2011
The recent economic recession raised concerns that child physical abuse rates would increase after a long period of decline, but federal data sources have not detected such changes. According to the National Child Abuse and Neglect Data System (NCANDS), the primary source of surveillance for child maltreatment in the U.S., the number of cases of physical abuse has been declining over the past 15 years. In light of severe and prolonged economic hardship since late 2007, there has been concern by small regional studies and case reports that prior trends may have been reversed. Following these reports that suggest hospital encounters for child abuse may be increasing, we examined trends in hospitalizations for child physical abuse in the context of economic trends in unemployment and housing foreclosure.
• To describe the trend in physical abuse admissions to pediatric hospitals from 2000 to 2009 in relationship to other injury admissions
• To examine the relationship between macroeconomic indicators and the rate of pediatric hospital admissions for injuries from physical abuse over time
Study Design: Retrospective study on trends of physical abuse admissions to 38 pediatric hospitals within the Pediatric Health Information System (PHIS) database, an administrative data resource of 43 participating hospitals located in 17 of the 20 major metropolitan areas in the U.S. Hospital data were linked to macroeconomic data for the associated metropolitan statistical area (MSA). The primary outcome measures were monthly hospital admission rates of physical abuse, high-risk traumatic brain injury (TBI), and all-cause injury. The primary predictor measures were macroeconomic indicators of monthly unemployment rate, monthly mortgage foreclosure rate, and monthly 90-day mortgage delinquency rate.
• Children under age 6 discharged with a diagnosis of physical abuse or assault
• Infants less than 12 months of age discharged with diagnosis of TBI, a high-risk injury that carries a strong likelihood of abuse
• All children with a discharge diagnosis of injury
Hospital data suggest that rates of severe physical abuse are increasing. Identifying ways to collaboratively monitor the safety of children at a population level using multiple sources of information, including hospital data, can inform a more comprehensive response to child maltreatment.
Of particular concern is the relationship between the trend of child physical abuse and housing security issues. An accurate understanding of this relationship could stimulate dialogue and collaboration among health care, child welfare, and housing agencies. This type of collaborative effort would enable a more targeted response to the needs of children. Further research is needed to examine community-level impact of the housing crisis on child wellbeing and safety.
Wood JN, Medina SP, Feudtner C, Luan X, Localio R, Fieldston ES, Rubin DM. (2012) Local macroeconomic trends and hospital admissions for child abuse, 2000-2009. Pediatrics.