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Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment
Fereshteh Salimi-Jazi1, Norah E Liang1, Zhuoyi Huang1
1Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
Insights
Black children and adolescents show higher rates of suspected child abuse compared to other racial groups. Further research is needed to understand and reduce these disparities in identification.
Area of Science:
- Pediatric Trauma
- Child Abuse Identification
- Health Disparities
Background:
- Child abuse is a significant cause of childhood morbidity, yet accurate detection remains a challenge.
- Racial and ethnic disparities in the suspicion for child abuse (SCA) among pediatric trauma patients require investigation.
Purpose of the Study:
- To describe racial and ethnic disproportionalities in the suspicion for child abuse (SCA) among pediatric patients admitted after traumatic injury.
- To analyze the association between race/ethnicity and SCA in pediatric trauma cases.
Main Methods:
- Retrospective, multicenter cross-sectional study using the Kids' Inpatient Database (KID) from 2006-2019.
- Analysis of a national sample of children (<18 years) admitted for pediatric trauma, comparing demographics, injury severity, and hospitalization characteristics by race and ethnicity.
- Identification of SCA cases using ICD-9-CM and ICD-10-CM codes for child maltreatment.
Main Results:
- Among 634,309 pediatric trauma patients, 13,579 had SCA. Black and Hispanic patients were overrepresented in the SCA subgroup compared to the US Census.
- After controlling for socioeconomic factors, Black race remained an independent risk factor for SCA (OR, 1.10), while Hispanic race showed a protective association (OR, 0.71).
- Black patients with SCA experienced significantly longer lengths of stay compared to White patients with similar injury severity.
Conclusions:
- Black children and adolescents exhibit higher rates of suspected child abuse following traumatic injury compared to other racial and ethnic groups.
- Significant racial and ethnic disparities exist in child abuse identification, with Black children being disproportionately affected.
- Further research is essential to elucidate the origins of these disparities and develop strategies for equitable child abuse identification.
Importance:
Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging.
Objective:
To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury.
Design, Setting, And Participants:
This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024.
Exposure:
The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment.
Main Outcome And Measure:
The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA.
Results:
Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P < .001) for serious injury.
Conclusion And Relevance:
In this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.
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