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Abusive head trauma during a time of increased unemployment: a multicenter analysis
Rachel P Berger1, Janet B Fromkin, Haley Stutz
1Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15224, USA. rachel.berger@chp.edu
Insights
The rate of abusive head trauma (AHT) in children under 5 increased significantly during an economic recession. This study found no link between AHT rates and local unemployment, but suggests increased prevention efforts during hardship.
Area of Science:
- Pediatrics
- Public Health
- Sociology
Background:
- Abusive head trauma (AHT) is a serious concern in child abuse cases.
- Economic downturns are associated with increased societal stress, potentially impacting child maltreatment rates.
Purpose of the Study:
- To examine the incidence of abusive head trauma (AHT) in young children across three U.S. regions before and during an economic recession.
- To determine if county-level unemployment rates correlate with AHT incidence.
Main Methods:
- A retrospective analysis of AHT cases in children under 5 years old was conducted from January 2004 to June 2009.
- Data were gathered from hospital-based child protection teams in three geographic regions.
- Quarterly county-level unemployment data were collected for comparison.
Main Results:
- A total of 422 AHT cases were identified over the study period.
- The AHT rate rose from 8.9 to 14.7 per 100,000 children during the recessionary period (P < .001).
- No significant relationship was found between AHT rates and county unemployment levels.
Conclusions:
- AHT incidence significantly increased during the economic recession compared to the pre-recession period.
- The rise in AHT aligns with the known effects of stress on violence.
- Increased prevention strategies for AHT are recommended during economic hardship due to high child morbidity and mortality.
Objective:
To evaluate the rate of abusive head trauma (AHT) in 3 regions of the United States before and during an economic recession and assess whether there is a relationship between the rate of AHT and county-level unemployment rates.
Methods:
Clinical data were collected for AHT cases diagnosed in children younger than 5 years from January 1, 2004 until June 30, 2009, by hospital-based child protection teams within 3 geographic regions. The recession was defined as December 1, 2007 through June 30, 2009. Quarterly unemployment rates were collected for every county in which an AHT case occurred.
Results:
During the 5½-year study period, a total of 422 children were diagnosed with AHT in a 74-county region. The overall rate of AHT increased from 8.9 in 100,000 (95% confidence interval [CI]: 7.8-10.0) before the recession to 14.7 in 100,000 (95% CI: 12.5-16.9) during the recession (P < .001). There was no difference in the clinical characteristics of subjects in the prerecession versus recession period. There was no relationship between the rate of AHT and county-level unemployment rates.
Conclusions:
The rate of AHT increased significantly in 3 distinct geographic regions during the 19 months of an economic recession compared with the 47 months before the recession. This finding is consistent with our understanding of the effect of stress on violence. Given the high morbidity and mortality rates for children with AHT, these results are concerning and suggest that prevention efforts might need to be increased significantly during times of economic hardship.
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