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Updated: May 29, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Neighborhood deprivation is a risk factor for severe child physical abuse: A multicenter cohort investigation
Nicole A Wilson1, Luis Ruffolo, Peter Juviler
1From the Division of Pediatric Surgery, Department of Surgery (N.A.W., D.S.W.), Golisano Children's Hospital, University of Rochester Medical Center; Department of Biomedical Engineering (N.A.W.), University of Rochester; Department of Surgery (L.R., P.J.), University of Rochester Medical Center, Rochester; Department of Surgery (T.F., W.K., D.L.), University at Buffalo, Buffalo; Department of Surgery (M.E., N.V., R.C.), Albany Medical College, Albany; Department of Surgery (K.W., A.C.), SUNY Upstate Medical University, Syracuse; Division of Pediatric Surgery (R.K.-C., F.B., J.P.), Cohen Children's Medical Center, Queens; and Department of Anesthesiology (I.S., J.F.) and Department of Surgery, Westchester Medical Center, Valhalla, New York.
Insights
Neighborhood deprivation is linked to increased odds of confirmed child physical abuse and worse outcomes, including higher mortality. This highlights the impact of socioeconomic factors on child abuse severity and survival.
Area of Science:
- Pediatric Trauma
- Child Abuse Epidemiology
- Social Determinants of Health
Background:
- Child physical abuse is a significant public health concern.
- Socioeconomic factors, such as neighborhood deprivation, may influence child abuse.
- Understanding these associations is crucial for effective prevention and intervention.
Purpose of the Study:
- To investigate the association between neighborhood deprivation and outcomes in children experiencing physical abuse.
- To test the hypothesis that community-level social determinants of health worsen outcomes after child physical abuse.
Main Methods:
- A multicenter retrospective review of children (≤18 years) with suspected or confirmed physical abuse.
- Area Deprivation Index (ADI) assigned based on patient address; categorized into quartiles.
- Logistic regression used to analyze the association between ADI and confirmed abuse, controlling for covariates.
Main Results:
- Higher Area Deprivation Index (ADI) scores were associated with confirmed child physical abuse.
- Patients from the most deprived neighborhoods (fourth ADI quartile) had 2.65 times higher odds of confirmed abuse compared to the least deprived.
- Increased mortality and longer hospital stays were observed in children from more deprived neighborhoods.
Conclusions:
- A dose-dependent relationship exists between socioeconomic disadvantage and child physical abuse.
- Neighborhood deprivation is associated with poorer outcomes, including increased mortality, in child physical abuse cases.
- Findings support interdisciplinary and multiscale approaches for primary prevention of child physical abuse.
Background:
Our purpose was to investigate whether neighborhood deprivation is associated with outcomes in a multicenter population of children with suspected or confirmed child physical abuse. We hypothesized that community level social determinants of health are associated with worse outcomes following child physical abuse.
Methods:
This multicenter retrospective review included children (18 years or younger) admitted with suspected or confirmed physical abuse at six pediatric trauma centers. A national Area Deprivation Index (ADI) score was assigned to each patient based on home address. Area Deprivation Index was divided into quartiles using the distribution of our dataset. Exclusion of a caregiver at discharge was used as a proxy for confirmed physical abuse. Descriptive statistics and stepwise logistic regression were used to identify covariates. Multiple logistic regression was used to test for associations between ADI and caregiver exclusion.
Results:
Of 1,105 included patients, 512 had confirmed abuse. These patients were younger (median [interquartile range], 0.50 [1.50] vs. 0.83 [1.67]; p = 0.002), more likely to be Black or African American (28.3% vs. 19.5%, p < 0.001), and had higher ADI scores (81.0 [35.0] vs. 66.0 [60.0], p < 0.001). A dose-dependent relationship between ADI and caregiver exclusion was identified. Compared with those from the least vulnerable neighborhoods (ADI first quartile), patients from the most vulnerable neighborhoods (ADI fourth quartile) had 2.65 (95% confidence interval, 1.73-4.08; p < 0.001) times higher odds of confirmed abuse. Despite no differences in Injury Severity Scores (8.0 [6.0] vs. 9.0 [10.0], p = 0.163), they also had longer lengths of hospital stay (1.0 [2.0] vs. 3.0 [2.8], p = 0.002) and higher mortality (1.5% vs. 5.0%, p = 0.028).
Conclusion:
This large multicenter experience demonstrates a dose-dependent relationship between socioeconomic disadvantage and child physical abuse. We further demonstrate that disadvantage is associated with worse outcomes, including increased mortality, in child physical abuse. These findings provide objective data and lead to suggestions for interdisciplinary and multiscale approaches to primary prevention of child physical abuse.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
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