1. Using nationally representative retrospective data of children 0 to 4 years old, authors found that children living in counties with the highest poverty concentration had 3 times the rate of child abuse fatalities compared to counties with the lowest poverty concentration.
2. African American children in counties with lowest poverty concentration had higher rates of fatalities from child abuse compared to white children in counties with highest poverty concentration.
Evidence Rating Level: 2 (Good)
Study Rundown: Children living in poverty face many health disparities, including increased lead levels, structural differences in brain development, and death from unintentional injury. Individual poverty is a well-known risk factor for child abuse. Few studies, however, have explored the effect of community poverty on child abuse. This study is the first to employ a nationally representative sample of young children to explore the effect of community poverty on child abuse fatality rates. Overall, children under 1 year old represented a disproportionally high rate of abuse fatalities. In addition, African American children experienced higher fatality rates compared to all other races. Child abuse fatality rates increased with increasing proportion of community poverty. Overall, child abuse fatality rates had a small but significant decrease over time. This study highlights high-risk areas for public health officials to target their prevention and resource efforts. While these findings reveal a strong relationship between poverty, race, and child abuse fatalities, they may underestimate the true fatality rate due to the somewhat subjective methods of determining cause of death via death certificate data.
In-Depth [retrospective cohort]: This study used the Centers for Disease Control and Prevention Compressed Mortality Files (CMF) to determine child abuse fatality rates among children 0 to 4 years old from 1999 to 2014 (N=11 149). Population and poverty statistics were obtained using US census data, with county poverty concentrations categorized into 0-4.9%, 5-9.9%, 10-14.9%, 15-19.9%, and >20%. The national child abuse fatality rate was 3.5 deaths per 100,000 children 0 to 4 years old. Although children 12 months and under make up 20% of the US population of 0 to 4 year olds, they comprised 45% of child abuse fatalities (5053). African American children 0 to 4 years old represent 16% of that age group, but 37% (4174) of fatalities in that same group. Counties with the lowest poverty rate had the lowest fatality rate (1.3 per 100,000), and counties with >20% poverty had the highest fatality rates (4.5 per 100,000). African American children in counties with the lowest poverty concentration had a fatality rate of 5.1 per 100,000 African American children. This rate is higher than that of whites in counties with the highest poverty concentration (3.2 per 1000,000 white children). Compared to the counties with the lowest poverty concentration, counties with the highest concentration of poverty had 3.03 times the rate of child abuse fatalities (aIRR* 3.03, 95% CI 2.43-3.79).
*adjusted incidence rate ratio
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