Child Maltreatment in the US

154216694How many children are maltreated, with 'maltreatment' including neglect, sexual, physical or emotional abuse, each year in the United States?  While it's a safe bet no one really knows the absolute number, a very sobering study Rick and I discuss on PodMed this week and published in JAMA Pediatrics attempts to estimate that number, with disconcerting results.  And by the way, almost everyone agrees said results are almost surely an underestimate.  Okay, what about the study?

Researchers crunched data from the National Child Abuse and Neglect Data System (NCANDS) Child File, which included reports on 5 689 900 children filed between 2004 and 2011 of maltreatment confirmed by Child Protective Services. The main outcome measures of the analysis include the cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year.

Here are the numbers, directly from the manuscript: "At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010."

Yikes!  I am especially taken aback by the fact that most maltreatment occurs while children are very young, and often preverbal. Rick and I both agree that the onus is on healthcare providers, who may be some of the few people who will interact with children at this point in their lives, to be on hyperalert to signs of maltreatment. Rick also points out, as do the authors of the study, that child maltreatment really is a health issue: those who have been maltreated as children are at greater risk for obesity, HIV infection, and mortality than those who have not been maltreated.  They're more likely to engage in criminal behavior, experience mental health problems, and are 5 times as likely to attempt suicide as their non-maltreated counterparts. Indeed, the authors provide the estimate that the cost to society of child maltreatment exceeds or equals that of stroke and type 2 diabetes!

Clearly, these rates of child maltreatment are intolerable.  As the authors state, "these data highlight that the burden of confirmed maltreatment is far greater than suggested by single-year national estimates of confirmed child maltreatment and that the risk for maltreatment is particularly high for black children (between 1 in 4 and 1 in 5, my addition)." This study provides us with greater awareness of the problem, now policies and practices must be developed and implemented to address what is obviously a public health issue.

Other topics this week include the utility of colorectal cancer screening in previously unscreened elderly in Annals of Internal Medicine, and two from the BMJ: early stroke thrombolysis benefit, and the statin/diabetes relationship.  Until next week, y'all live well.

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