Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse.
This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities.
From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were <1 year old, 56% (6283) were boys, and 58% (6480) were white. The overall rate of fatal child abuse was 3.5 per 100 000 children 0 to 4 years old. In the multivariate model, counties with the highest poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4–3.79).
Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources.
Comments
RE: Community Poverty and Child Abuse Fatalities in the United States
Dr. Farrell et al have documented yet another tragic consequence of American poverty for American children, a threefold rise in the chance of being physically abused. Their article also documents the other hazard of being American, the increased risk of abuse simply by having more pigment. From infant mortality to shorter life expectancy, from mortality rates for a wide range of diseases to the risk of being physically attacked, being poor or being black in America makes disease and injury far more likely and ends life early.
The AAP has done an admirable job in highlighting the central tragedy of poverty in America. Now it is time for our Academy to take the next step. The data are in place, it is time to end the plague. We have taken on large implacable causes of death and disability before, including polio and smallpox. Social determinants of health are just that, causes of death and disability due to socially agreed upon actions, or determinants. The Academy works hard every day to push the choices our American community makes towards social determinants of health.
All of us should be supporting our Academy in these extremely important efforts, and push for the next steps which will be a bold, clear renunciation of poverty and racism. Our children rely on us, their trusted professionals to protect and promote their lives. Poverty and racism are proven killers, we should work with our Academy to set a new standard for our American community, it is time for our nation to pass the laws, invest the funds, take the actions that will bring an end to these greatest challenges to the American dream.
The American Academy of Pediatrics was founded partly because US pediatricians insisted that no child in the country starve for lack of free milk (https://digital.library.txstate.edu/bitstream/handle/10877/4227/MORLEY-T...). We began as an organization committed to see no child suffer as a result of social decisions. Let us join together once again to say that starting now, poverty and racism are no longer acceptable choices for our national community. We have done so much work in this direction, let us take the next step and say poverty and racism need to go the way of smallpox and soon polio. There will, of course, be no vaccine for poverty and racism, but we as a nation created these scourges, and what one has created, one can change. The Academy is highly respected as voice for children, has command of vast proofs of the causes and impacts of racism and poverty, let’s set a new standard and hold our nation accountable to it. Let us end poverty and racism, our children cry out to us to do this.
Arthur Lavin, MD, FAAP
Cleveland, Ohio