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Emergency Department Admissions for Physical Child Abuse: Evidence from the 2006-2017 Nationwide Emergency Department
Jason T Carbone1, Kristen P Kremer2, Katherine J Holzer3
1Wayne State University, Detroit, MI, USA.
Insights
Physical child abuse is a significant public health concern. This study found that children with physical abuse diagnoses were more likely to be uninsured and have behavioral health conditions like ADHD, and less likely to be from higher-income families.
Area of Science:
- Public Health
- Pediatrics
- Child Abuse Research
Background:
- Physical child abuse remains a critical public health issue in the U.S.
- Previous research highlights the need to understand trends and risk factors for child abuse diagnoses.
Purpose of the Study:
- To analyze trends in physical child abuse diagnoses among children in U.S. emergency departments (EDs).
- To identify sociodemographic and behavioral health factors associated with ED admissions for physical child abuse.
- To compare differences between confirmed and suspected physical child abuse cases.
Main Methods:
- Utilized a nationally representative sample of hospital-owned EDs (2006-2017).
- Included over 319 million ED admissions for children under 18.
- Employed trend analysis, descriptive statistics, and multivariate logistic regression.
Main Results:
- Children with physical abuse diagnoses were less likely to be from higher-income communities (aOR=0.61) and more likely to be uninsured (aOR=1.65).
- Attention-deficit hyperactivity disorder (aOR=1.36) and conduct disorder (aOR=1.28) were associated with higher odds of physical abuse diagnoses.
- Sex-stratified analyses revealed distinct patterns for ADHD (males) and conduct disorder (females).
Conclusions:
- Sociodemographic factors (income, insurance status) and behavioral health conditions are significant risk factors for physical child abuse.
- Understanding these factors is crucial for informing interventions and preventing recurrent abuse.
- Differences exist between confirmed and suspected abuse cases, warranting further investigation.
Abstract:
Physical child abuse continues to be a serious public health issue in the United States. This study expands on previous research by exploring trends in physical child abuse diagnoses among children admitted to emergency departments (EDs) across the United States. The analysis aimed to explicate the association between physical child abuse and both sociodemographic and behavioral health covariates to better inform and identify risk factors associated with ED admissions for abuse. The study also explicated differences between confirmed and suspected physical child abuse cases. The study utilized a nationally representative sample of hospital-owned EDs that included 319,676,625 ED admissions between 2006 and 2017 for children under 18-years-old. The analysis included a trend analysis, bivariate descriptive statistics, and multivariate logistic regression models were employed. Children with a physical child abuse diagnosis were less likely to be from higher income communities (aOR = 0.61, 95% CI [0.53, 0.71]), less likely to be female (aOR = 0.93, 95% CI [0.90, 0.96]), and more likely to be uninsured (aOR = 1.65, 95% CI [1.48, 1.84]). Children with attention-deficit hyperactivity disorder (aOR = 1.36, 95% CI [1.14, 1.62]) and a conduct disorder (aOR = 1.28, 95% CI [1.04, 1.58]) were more likely to have a physical abuse diagnosis. The sex-stratified analyses found that the higher rates of physical abuse among children with attention-deficit hyperactivity disorder were driven by the male subsample, while higher rates of abuse for those with conduct disorders were the result of the female subsample. A supplemental analysis of suspected versus confirmed physical child abuse for the fourth quarter of 2015 through 2017 also revealed sociodemographic and behavioral health differences. This study supports the need to consider sociodemographic and behavioral risk factors associated with physical child abuse to inform treatment and potential reoccurrence of abuse.
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