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Increase of child abuse admissions tied to recession

The number of children admitted to the nation’s largest pediatric hospitals for physical abuse has significantly increased, according to The Children’s Hospital of Philadelphia’s PolicyLab. The rise in admissions has been associated with local mortgage delinquencies and foreclosures, a measure of the recent recession.

In a study published in Pediatrics, Joanne N. Wood, MD, MSHP, and colleagues from The Children’s Hospital of Philadelphia (CHOP) analyzed data from 38 hospitals included in the Pediatric Hospital Information System. They looked at the admission rates for physical abuse in children aged 6 years or younger, traumatic brain injury in infants aged younger than 1 year and overall injuries. Admission data ranged from 2000 to 2009. The researchers linked hospital data to unemployment, mortgage delinquency and foreclosure data associated with  major US metropolitan areas in which the children’s hospitals were located.

Wood and colleagues performed Poisson fixed-effect regression analyses to estimate trends in physical abuse admission rates and associations between those rates and economic trends.

Results showed that child physical abuse admissions increased by 0.79% (95% CI, 0.13-1.44) per year from 2000 to 2009, and high-risk traumatic brain injuries increased by 3.1% (95% CI, 2.36-3.87). Overall injury rates fell by 0.8% (95% CI, 0.7-0.91) per year during the same period. Each 1% increase in 90-day mortgage delinquencies from the previous year was associated with a 3.09% increase in the child abuse admission rate (P=.005) and a 4.84% increase in admissions due to high-risk traumatic brain injuries suspected of being child abuse (P<.001). The researchers did not find an association between abuse admission rates and unemployment.

The CHOP findings contrast with national welfare data, which showed a decline in the number of child physical abuse cases during the same period.

“Ultimately, the challenge raised by this study is how best to monitor the safety and well-being of children at a population level and respond to the needs of families during times of economic hardship,” the researchers wrote. “Although this study cannot confirm a causal pathway between macroeconomic conditions and child abuse rates, it suggests the need to examine how society’s response to economic hardship can mitigate the risk to children.”

“As a pediatrician and researcher, I understand that child abuse is a complex issue,” Wood said. “This study is a reminder to all of us who treat children to be alert to challenges families may be facing and to help link them to appropriate social services when needed.”

Disclosure: Dr. Wood’s institution has received payment for expert witness court testimony that Dr. Wood has provided in cases of suspected child abuse. The other researchers report no relevant financial disclosures.