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Local macroeconomic trends and hospital admissions for child abuse, 2000-2009
Joanne N Wood1, Sheyla P Medina, Chris Feudtner
1PolicyLab and General Pediatrics, The Children's Hospital of Philadelphia 3535 Market St, Room 1517, Philadelphia, PA 19104, USA. woodjo@email.chop.edu
Insights
Economic downturns, specifically rising mortgage delinquency and foreclosure rates, correlated with increased pediatric physical abuse and traumatic brain injury (TBI) admissions. All-cause injury rates declined during this period.
Area of Science:
- Public Health
- Pediatrics
- Health Economics
Background:
- Pediatric physical abuse and traumatic brain injury (TBI) are significant public health concerns.
- Understanding the socioeconomic factors influencing these adverse events is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between local macroeconomic indicators and pediatric physical abuse admission rates.
- To analyze trends in high-risk traumatic brain injury (TBI) admissions as a proxy for abuse.
- To examine the relationship with all-cause injury rates as a control.
Main Methods:
- Retrospective analysis of pediatric hospital admission data from 38 hospitals (2000-2009).
- Linking hospital data with metropolitan statistical area (MSA) data on unemployment, mortgage delinquency, and foreclosure.
- Utilizing Poisson fixed-effects regression to model admission rates and macroeconomic trends.
Main Results:
- Physical abuse and high-risk TBI admissions increased annually (0.79% and 3.1%, respectively).
- All-cause injury rates decreased annually (0.80%).
- Abuse and high-risk TBI admission rates were positively associated with mortgage delinquency and foreclosure trends.
Conclusions:
- Pediatric physical abuse and high-risk TBI admissions rose during a period of declining overall injury rates.
- Local economic instability, indicated by mortgage delinquency and foreclosure, is linked to increased child abuse admissions.
- These findings highlight the impact of socioeconomic factors on child maltreatment.
Objective:
To examine the relationship between local macroeconomic indicators and physical abuse admission rates to pediatric hospitals over time.
Methods:
Retrospective study of children admitted to 38 hospitals in the Pediatric Hospital Information System database. Hospital data were linked to unemployment, mortgage delinquency, and foreclosure data for the associated metropolitan statistical areas. Primary outcomes were admission rates for (1) physical abuse in children <6 years old, (2) non-birth, non-motor vehicle crash-related traumatic brain injury (TBI) in infants <1 year old (which carry high risk for abuse), and (3) all-cause injuries. Poisson fixed-effects regression estimated trends in admission rates and associations between those rates and trends in unemployment, mortgage delinquency, and foreclosure.
Results:
Between 2000 and 2009, rates of physical abuse and high-risk TBI admissions increased by 0.79% and 3.1% per year, respectively (P ≤ .02), whereas all-cause injury rates declined by 0.80% per year (P < .001). Abuse and high-risk TBI admission rates were associated with the current mortgage delinquency rate and with the change in delinquency and foreclosure rates from the previous year (P ≤ .03). Neither abuse nor high-risk TBI rates were associated with the current unemployment rate. The all-cause injury rate was negatively associated with unemployment, delinquency, and foreclosure rates (P ≤ .007).
Conclusions:
Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends.
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