Racial Disparity and Disproportionality Among Emergency Department Visits for Child Maltreatment: Evidence From the...

Each year in the US, approximately 600,000 (8.1 per 1000 child population) children are victims of maltreatment. In 2023, rates among Black/African American children were 47% higher than the overall national rate. It is unclear whether similar disparities exist in national emergency department (ED) data, as the Nationwide Emergency Department Sample (NEDS) just began including race and ethnicity in data in 2019.

To evaluate racial disparity and disproportionality among a nationally representative sample of ED visits involving child maltreatment concerns.

International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes were used to identify ED visits for confirmed (T74) and suspected (T76) child maltreatment concerns in patients under 18 years old from 1/1/2019 to 12/31/2020. NEDS sampling weights were applied to produce national estimates. Racial disparity and disproportionality were calculated using the Disparity Index (DI) and the Disproportionality Representation Index (DRI), respectively.

A total of 29,667 ED visits (130,981 weighted) involving child maltreatment concerns were identified. The DRI revealed that non-Hispanic Black children had maltreatment codes applied at a rate that was 1.8 greater times what was expected given their proportion in the general population. The DI showed that non-Hispanic Black children were twice as likely to have a maltreatment-related diagnosis code applied when compared with their non-Hispanic White counterparts.

This research exposes racial differences in the application of diagnosis codes for child maltreatment concerns in a nationally representative ED sample. Future research should explore factors which may influence the application of maltreatment-related diagnosis codes.