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Children of Caregivers With Abuse-Related Adverse Childhood Experiences Have Higher Infection Rate and Higher
Melissa E Day1, Qing Duan2, Mary Carol Burkhardt3
1Division of Infectious Diseases (ME Day and EP Schlaudecker), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (ME Day, MC Burkhardt, M Klein, EP Schlaudecker, and AF Beck), University of Cincinnati College of Medicine, Cincinnati, Ohio.
Insights
Caregiver abuse-related adverse childhood experiences (ACEs) are linked to more frequent infections and healthcare visits in young children. This highlights the impact of caregiver trauma on pediatric health outcomes.
Area of Science:
- Pediatric Health
- Public Health
- Social Determinants of Health
Background:
- Caregiver adverse childhood experiences (ACEs) are associated with increased pediatric antibiotic prescriptions.
- Previous research has not explored the connection between caregiver ACEs and the frequency of childhood infections or related healthcare utilization.
Purpose of the Study:
- To investigate the association between abuse-related caregiver ACEs and the frequency of infections in young children.
- To examine the link between caregiver ACEs and infection-related healthcare utilization in pediatric patients.
Main Methods:
- A retrospective cohort study included 1,970 children aged 0-4 years from two pediatric primary care sites.
- The study assessed the presence of abuse-related caregiver ACEs and analyzed the number of infectious diagnoses and infection-related clinical encounters.
- Statistical analyses included chi-squared and negative binomial regression, adjusting for community deprivation and social risk factors.
Main Results:
- Children of caregivers with abuse-related ACEs had a significantly higher rate of two or more infectious diagnoses (37% vs. 29%, p=0.010).
- The presence of any abuse-related caregiver ACE was associated with a 15% increase in infection-related clinical encounters after adjusting for covariates (IRR 1.15).
Conclusions:
- Children aged 0-4 with caregivers reporting abuse-related ACEs experience a higher incidence of infections and utilize healthcare services more frequently for infections.
- Further research is warranted to elucidate the biological and behavioral mechanisms underlying these associations.
Objective:
Abuse-related caregiver adverse childhood experiences (ACEs) have been found to be associated with increased pediatric oral antibiotic prescriptions. However, no studies have examined links between such ACEs and frequency of infections or infection-related health care utilization.
Methods:
We conducted a retrospective cohort study including patients from 2 pediatric primary care sites, serving predominantly non-Hispanic Black, publicly insured pediatric patients. Outcomes were the number of infectious diagnoses (0, 1, or ≥2) and infection-related clinical encounters in children 0 to 4 years old. The presence of any abuse-related caregiver ACEs (physical, verbal, or sexual abuse experienced directly or witnessed by the caregiver) was our exposure of interest. Chi-square and negative binomial regression analyses were used to determine associations with frequency of infections and infection-related encounters, respectively. Pertinent covariates included a census tract-level Material Community Deprivation Index (linked to geocoded addresses) and answers to a standardized social risk screen.
Results:
We included 1970 children 0 to 4 years old (49% female, 78% Black, 2.6% Hispanic). Children of caregivers with abuse-related ACEs had a higher rate of having ≥2 infectious diagnoses (37%) compared to their counterparts without abuse-related ACEs (29%, P = .010). The presence of any abuse-related caregiver ACE was associated with a 15% higher rate of infection-related clinical encounters (incidence rate ratios 1.15, 95% confidence interval 1.0048-1.32) when adjusting for community deprivation and social risk screen responses.
Conclusions:
Children 0 to 4 years with caregivers reporting abuse-related ACEs have a higher rate of infections and infection-related health care utilization. Future studies are needed to evaluate underlying biological and behavioral mechanisms for these observations.
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