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Early predictors for maltreatment-related injuries in infancy and long-term mortality: a population-based study
Hsin-Hung Chen1,2, I-An Wang3, Tan-Wen Hsieh3
1Institute of Public Health, National Yang Ming Chiao Tung University, Medical Building II, No. 155, Sec. 2, Linong Street, Taipei, 112, Taiwan.
Insights
Child maltreatment disproportionately affects young children. Low birth weight and lack of postnatal care are key predictors of fatality in maltreated infants, highlighting the need for early intervention.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Child maltreatment poses significant health and social burdens, disproportionately affecting very young children.
- Understanding risk factors for maltreatment injuries and associated mortality in infants is crucial.
Purpose of the Study:
- To explore child- and family-level factors influencing diagnoses of maltreatment-related injuries in infants.
- To investigate factors associated with excessive mortality among toddlers exposed to maltreatment.
Main Methods:
- Retrospective cohort study of 2.2 million infants born in Taiwan (2004-2014).
- Defined incident child maltreatment via hospitalization or ED visits for maltreatment-related injuries within 12 months of birth.
- Utilized generalized linear models and landmark survival analyses to identify risk factors.
Main Results:
- An estimated 2.9‰ of infants experienced maltreatment-related injuries, with a 1.3% three-year mortality rate.
- Low birth weight significantly increased the risk of maltreatment diagnoses, especially maltreatment syndrome (aIRR=4.08).
- Socially advantaged family conditions were linked to lower risks of maltreatment syndrome and assaults but higher risks of undetermined causes.
- Low birth weight and non-attendance of postnatal care were strong predictors of mortality in maltreated infants; low birth weight predicted premature death in toddlerhood (aIRR=6.17).
Conclusions:
- Increased awareness of infant maltreatment injuries and their predictors is essential.
- Prioritizing follow-up assessments and timely interventions for at-risk infants is critical for reducing mortality and morbidity.
Introduction:
Incidence, health consequences, and social burden associated with child maltreatment appeared to be borne disproportionately by very young children. We conducted a population-based data linkage study to explore child- and family-level factors that affect receiving different diagnoses of maltreatment injuries and investigate excessive mortality throughout toddlerhood.
Methods:
We conducted a retrospective cohort study comprising 2.2 million infants born in 2004-2014 in Taiwan. Incident cases of child maltreatment were defined by hospitalization or emergency department visits for three heterogeneous diagnostic groups of maltreatment-related injuries (i.e., maltreatment syndrome, assaults, and undetermined causes) within 12 months after birth. The generalized linear model and landmark survival analyses were used to evaluate risk factors.
Results:
An estimated 2.9‰ of infants experienced at least one maltreatment-related injury, with a three-year mortality rate of 1.3%. Low birthweight was associated with increased risk of receiving the diagnosis of three maltreatment injuries, particularly maltreatment syndrome (adjusted Incidence Rate Ratio [aIRR] = 4.08, 95% confidence interval [CI]: 2.93-5.68). Socially advantaged family condition was inversely linked with receiving the diagnosis of maltreatment syndrome and assaults (e.g., high income: aIRR = 0.55 and 0.47), yet positively linked with undetermined cause (aIRR = 2.05, 95% CI: 1.89-2.23). For infants exposed to maltreatment, low birth weight and non-attendance of postnatal care were highly predictive of fatality; low birthweight served as a vital predictor for premature death during toddlerhood (aIRR = 6.17, 95% CI: 2.36-15.4).
Conclusions:
Raising awareness of maltreatment-related injuries in infancy and predictors should be a priority for appropriate follow-up assessment and timely intervention.
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