The economic burden of child maltreatment in the United States and implications for prevention
Open accessAbstract
OBJECTIVES: To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. METHODS: This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used attributable costs whenever possible. For those categories that attributable cost data were not available, costs were estimated as the product of incremental effect of child maltreatment on a specific outcome multiplied by the estimated cost associated with that outcome. The estimate of the aggregate lifetime cost of child maltreatment in 2008 was obtained by multiplying per-victim lifetime cost estimates by the estimated cases of new child maltreatment in 2008. RESULTS: The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion. CONCLUSIONS: Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment.
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Child sexual abuse has significant costs for institutions in health care, education, welfare assistance, child protection, and justice systems.
“These consequences are far-reaching into families and communities, with significant costs for institutions in terms of primary and rehabilitative health care, education and welfare assistance, child protection, and justice system costs (Fang 2012).”
From School-based education programmes for the prevention of child sexual abuse (2015) · cites this paper as Fang 2012
The Methods sections estimate health care, special education, child welfare, and criminal justice costs associated with child maltreatment. But the Discussion says the paper did not estimate costs by type of maltreatment, so those costs cannot all be attributed specifically to child sexual abuse. The copy addresses child welfare services, not welfare assistance as a separate cost category; page numbers were not provided. (LLM, conf=0.88)
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“Furthermore, some studies show a cor- in response to child abuse and neglect in 2008 are estimated to be approximately $124 billion ðFang et al. 2012Þ. relation between childmaltreatment and community- or state-level poverty rates ðCoulton et al. 1995, 2007; Drake and Pandey 1996Þ, unemployment…”
BackgroundSchofield, T. J., Lee, R. D., & Merrick, M. T. (2013) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2013.05.004 · Cited by 242 · see citing works
“A recent estimate places the total lifetime economic burden of new cases of child maltreatment in the United States at $124 billion with it rising to as much as $585 billion in sensitivity analysis [41].”
BackgroundRisk and Protective Factors for Physical and Sexual Abuse of Children and Adolescents in Africa
Meinck, F., Cluver, L. D., Boyes, M. E., & Mhlongo, E. L. (2014) · Trauma Violence & Abuse · doi:10.1177/1524838014523336 · Cited by 244 · see citing works
The enduring impact of violence against children
Hillis, S. D., Mercy, J. A., & Saul, J. R. (2016) · Psychology Health & Medicine · doi:10.1080/13548506.2016.1153679 · Cited by 246 · see citing works
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“These life course perspectives on ACEs expose their long-term health and financial costs to individuals and public services [6, 7].”
BackgroundLifetime Economic Burden of Rape Among U.S. Adults
Peterson, C., DeGue, S. A., Florence, C., & Lokey, C. N. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.11.014 · Cited by 224 · see citing works
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The burden of child maltreatment in the East Asia and Pacific region
Fang, X., Fry, D. A., Brown, D. S., Mercy, J. A., Dunne, M. P., Butchart, A., Corso, P. S., Maynzyuk, K., Dzhygyr, Y., Chen, Y., et al. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.02.012 · Cited by 187 · see citing works
Self-citationThe economic burden of child sexual abuse in the United States
Letourneau, E. J., Brown, D. S., Fang, X., Hassan, A. N., & Mercy, J. A. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.02.020 · Cited by 191 · see citing works
“The national economic costs of child maltreatment have been estimated in numerous studies (Daro, 1988; Fang et al., 2012; Fromm, 2001; Gelles & Perlman, 2012; Miller et al., 1996; Wang & Holton, 2007) and highlighted in numerous reports (e.g., Florence, Brown, Fang, & Thompson, 2013; IOM & NRC,…”
InfluentialSelf-citationChild Maltreatment and Developmental Psychopathology: A Multilevel Perspective
Cicchetti, D., & Toth, S. L. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy311 · Cited by 184 · see citing works
Income and child maltreatment in unmarried families: evidence from the earned income tax credit
Berger, L. M., Font, S. A., Slack, K. S., & Waldfogel, J. (2016) · Review of Economics of the Household · doi:10.1007/s11150-016-9346-9 · Cited by 181 · see citing works
“body of work and the considerable public and private costs of child maltreatment (Fang et al., 2012), there is a striking dearth of evidence on whether this relation is causal.”
The relationship between poverty, child abuse and neglect: an evidence review.
Bywaters, P., Bunting, L., Davidson, G., Hanratty, J., Mason, W., McCartan, C. J., & Steils, N. (2016) · Coventry University Open Collections (Coventry university) · Cited by 178 · see citing works
Burden attributable to child maltreatment in Australia
Moore, S. E., Scott, J. G., Ferrari, A. J., Mills, R. J., Dunne, M. P., Erskine, H. E., Devries, K. M., Degenhardt, L. J., Vos, T., Whiteford, H., et al. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.05.006 · Cited by 170 · see citing works
Relationship between adverse childhood experiences and unemployment among adults from five US states
Liu, Y., Croft, J. B., Chapman, D. P., Perry, G. S., Greenlund, K. J., Zhao, G., & Edwards, V. J. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-012-0554-1 · Cited by 200 · see citing works
“3 million maltreated or neglected children reported to US state and local child protective services in 2008 [39].”
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“Indeed, the CDC estimates a $124 billion aggregate lifetime economic burden incurred by victims of child maltreatment alone in the US (Fang et al., 2012), surpassing the combined economic costs of all other major pediatric health problems, including autism, asthma, pediatric cancers, exposure to environmental toxins,…”
BackgroundThe Neurobiology and Psychology of Pedophilia: Recent Advances and Challenges
Tenbergen, G., Wittfoth, M., Frieling, H., Ponseti, J., Walter, M., Walter, H., Beier, K. M., Schiffer, B., & Krüger, T. H. C. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00344 · Cited by 156 · see citing works
“The estimated burden for the particular countries is enormous, including childhood health care costs, adult medical costs, productivity losses, criminal justice costs, and special education costs, which results in an estimated lifetime cost per victim of non-fatal child maltreatment in general of $210,000 in the USA (…”
BackgroundBarrios, Y. V., Gelaye, B., Zhong, Q., Nicolaidis, C., Rondón, M. B., García, P. J. G., Sánchez, P. M., Sánchez, S. E., & Williams, M. A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0116609 · Cited by 166 · see citing works
“Childhood abuse has been shown to be associated with serious adverse health consequences across the life course [1–4].”
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“While NCANDS provides official reports of child abuse and neglect, the National Survey of Children’s Exposure to Violence (NatSCEV) provides self-reported data on violence against children through a nationally representative random-digit dial survey of children (0-9) and youth (10-18).”
BackgroundDierkhising, C. B., Ford, J. D., Branson, C. E., Grasso, D. J., & Lee, R. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.07.022 · Cited by 141 · see citing works
Vlahovicova, K., Meléndez‐Torres, G. J., Leijten, P. H. O., Knerr, W., & Gardner, F. E. M. (2017) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-017-0232-7 · Cited by 139 · see citing works
“The societal burden of child physical abuse is exorbitant—the lifetime economic cost for all new cases of abuse in one calendar year in the US has been estimated at $124 billion (Fang et al. 2012).”
BackgroundBuilding Capacity for Trauma-Informed Care in the Child Welfare System
Lang, J. M., Campbell, K., Shanley, P., Crusto, C. A., & Connell, C. M. (2016) · Child Maltreatment · doi:10.1177/1077559516635273 · Cited by 138 · see citing works
“The significant costs of child maltreatment (Fang et al., 2012) and the established benefits of early intervention and trauma-focused EBPs (Lee, Aos, & Pennucci, 2015) suggest that cost savings are certainly plausible.”
BackgroundWeber, S., Jud, A., & Landolt, M. A. (2015) · Quality of Life Research · doi:10.1007/s11136-015-1085-5 · Cited by 130 · see citing works
Systematic review and critical appraisal of child abuse measurement instruments
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Social determinants of health and child maltreatment: a systematic review
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“The combined human and institutional cost attributed to maltreatment morbidity and mortality in the US is estimated to be $124 billion annually.(3) The World Health Organization defines social determinants of health (SDH) as “the conditions in which people are born, grown, work, live, and age, and the wider set of for…”
BackgroundCameron, L. D., Carroll, P., & Hamilton, W. K. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.03.002 · Cited by 125 · see citing works
Medical-Legal Strategies to Improve Infant Health Care: A Randomized Trial
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“E-mail: cdkilts@uams.edu Received for publication 14 May 2012; Revised 7 February 2013; Accepted 8 February 2013 DOI: 10.1002/hbm.22280 Published online 24 April 2013 in Wiley Online Library (wileyonlinelibrary.com).”
BackgroundInfluentialMejdoubi, J., van den Heijkant, S. C. C. M., van Leerdam, F. J. M., Heymans, M. W., Crijnen, A. A. M., & Hirasing, R. A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0120182 · Cited by 124 · see citing works
“[5] The mortality and morbidity associated with child maltreatment are assumed to be potentially preventable.”
BackgroundUniversal violence and child maltreatment prevention programs for parents: A systematic review
Altafim, E. R. P., & Linhares, M. B. M. (2016) · Psychosocial Intervention · doi:10.1016/j.psi.2015.10.003 · Cited by 131 · see citing works
Adverse Childhood Experiences and Health-Risk Behaviors in Vulnerable Early Adolescents
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Violence against children surveys (VACS): towards a global surveillance system
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“However, the conservative estimated lifetime costs per victim is $210,012 for nonfatal child maltreatment or $1,272,900 for a death from child maltreatment (in 2010 dollars) for a total estimated economic burdern in the US for one year of $124 billion (10).”
BackgroundA Review of Developmental Research on Resilience in Maltreated Children
Klika, J. B., & Herrenkohl, T. I. (2013) · Trauma Violence & Abuse · doi:10.1177/1524838013487808 · Cited by 122 · see citing works
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“Abbreviations ACE-IQ: Adverse childhood experiences international questionnaire; ACEs: Adverse childhood experiences; CDC: Centers for disease control and prevention; CHD: Coronary heart disease; DALY: Disability adjusted life years; KAIMRC: King Abdullah International Medical Research Center; KSA: Kingdom of Saudi Ar…”
BackgroundRidout, K. K., Khan, M. B., & Ridout, S. J. (2018) · BioEssays · doi:10.1002/bies.201800077 · Cited by 118 · see citing works
Testing for Abuse in Children With Sentinel Injuries
Lindberg, D. M., Beaty, B. L., Juarez‐Colunga, E., Wood, J. N., & Runyan, D. K. (2015) · PEDIATRICS · doi:10.1542/peds.2015-1487 · Cited by 117 · see citing works
Love, S. M., Sanders, M. R., Turner, K., Maurange, M., Knott, T. F., Prinz, R. J., Metzler, C. W., & Ainsworth, A. T. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.10.031 · Cited by 119 · see citing works
Baglivio, M. T., & Wolff, K. T. (2020) · Youth Violence and Juvenile Justice · doi:10.1177/1541204020972487 · Cited by 123 · see citing works
“Adverse childhood exposures carry one of the costliest lifetime public health expenditures (Fang et al., 2012; Putnam, 2006).”
BackgroundHerrenkohl, T. I., Fedina, L., Roberto, K. A., Raquet, K. L., Hu, R. X., Rousson, A. N., & Mason, W. A. (2022) · Trauma, Violence, & Abuse · doi:10.1177/1524838020939119 · Cited by 119 · see citing works
“Each incident of fatal and nonfatal child maltreatment renders lifetime per victim costs of US$1.2 million and US$210,012, respectively (Fang et al., 2012).”
BackgroundInfluentialBywaters, P., Brady, G., Sparks, T. H., Bos, E. P., Bunting, L., Daniel, B. M., Featherstone, B., Morris, K., & Scourfield, J. (2015) · Children and Youth Services Review · doi:10.1016/j.childyouth.2015.07.017 · Cited by 115 · see citing works
Breaking the Cycle of Maltreatment: The Role of Safe, Stable, and Nurturing Relationships
Thornberry, T. P., Henry, K. L., Smith, C. A., Ireland, T. O., Greenman, S. J., & Lee, R. D. (2013) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2013.04.019 · Cited by 115 · see citing works
“Yet relatively little research has focused on either the developmental pathways associated with maltreatment perpetration or the buffering protective factors that safeguard against risk of perpetration (19, 20).”
Benedini, K. M., Fagan, A. A., & Gibson, C. L. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2016.08.003 · Cited by 113 · see citing works
Childhood Maltreatment and Impulsivity: A Meta-Analysis and Recommendations for Future Study
Liu, R. T. (2018) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-018-0445-3 · Cited by 113 · see citing works
“time economic cost is $124 billion for all new cases of child maltreatment in a given year (Fang et al. 2012).”
BackgroundBrindle, R. C., Pearson, A., & Ginty, A. T. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104530 · Cited by 112 · see citing works
Parent-Focused Prevention of Child Sexual Abuse
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“…associated with offenders’ prosecution, incarceration, and monitoring; victims’ medical and psychiatric costs; effects on victims’ families, relationships, and school and workplace performance; victims’ quality of life; and reduced life expectancy (Fang et al. 2012; Havinsky and Draker 2003).”
BackgroundAdverse childhood experiences, dispositional mindfulness, and adult health
Whitaker, R. C., Dearth-Wesley, T., Gooze, R. A., Becker, B. D., Gallagher, K. C., & McEwen, B. S. (2014) · Preventive Medicine · doi:10.1016/j.ypmed.2014.07.029 · Cited by 110 · see citing works
Longitudinal Outcomes for Victims of Child Abuse
Buckingham, E. T., & Daniolos, P. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-012-0342-3 · Cited by 108 · see citing works
“However, utilizing only confirmed cases of maltreatment, there is an estimated annual cost of $124 billion dollars to the US health-care system alone [3].”
BackgroundPrevalence of Child Maltreatment in Israel: A National Epidemiological Study
Lev-Wiesel, R., Eisikovits, Z., First, M., Gottfried, R., & Mehlhausen, D. (2016) · Journal of Child and Adolescent Trauma · doi:10.1007/s40653-016-0118-8 · Cited by 100 · see citing works
Long-Term Impact of Childhood Abuse and Neglect on Crime and Violence
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“in the USA to result in lifetime costs of $10,530 in adult medical needs and $144,360 in lost productivity.(22) In the UK, the annual costs to adult mental health and substance use services related to childhood sexual abuse have been estimated at £178 million.”
BackgroundInterpersonal Violence: Global Impact and Paths to Prevention
Mercy, J. A., Hillis, S. D., Butchart, A., Bellis, M. A., Ward, C. L., Fang, X., & Rosenberg, M. L. (2017) · World Bank, Washington, DC eBooks · doi:10.1596/978-1-4648-0522-6_ch5 · Cited by 106 · see citing works
Self-citationHealth Care Costs Associated With Child Maltreatment: Impact on Medicaid
Florence, C., Brown, D. S., Fang, X., & Thompson, H. F. (2013) · PEDIATRICS · doi:10.1542/peds.2012-2212 · Cited by 104 · see citing works
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“Concerns about the costs of implementing new screening or assessment protocols are reasonably offset by national estimates regarding the economic burden of child maltreatment on the child serving service sector (Fang et al. 2012), which reached 124 billion dollars in 2010.”
BackgroundSchaefer, L. M., Howell, K. H., Schwartz, L. E., Bottomley, J. S., & Crossnine, C. B. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.08.019 · Cited by 103 · see citing works
Benson, M. S., & Powell, M. B. (2015) · Psychology Public Policy and Law · doi:10.1037/law0000052 · Cited by 98 · see citing works
Child Sexual Abuse and the Media: A Literature Review
Weatherred, J. L. (2015) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2015.976302 · Cited by 100 · see citing works
“The average lifetime cost of each victim of nonfatal child abuse is estimated to be $210,000, therefore the treatment for all child abuse—including CSA—can potentially cost more than other significant health conditions, including stroke and type 2 diabetes (Fang et al., 2012).”
BackgroundLangevin, R., Marshall, C., & Kingsland, E. (2019) · Trauma, Violence, & Abuse · doi:10.1177/1524838019870917 · Cited by 93 · see citing works
“The estimated economic lifetime burden of maltreatment is 124 billion dollars (Fang, Brown, Florence, & Mercy, 2012).”
Racine, N. M., Eirich, R., Dimitropoulos, G., Hartwick, C., & Madigan, S. L. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104375 · Cited by 99 · see citing works
Ameliorating the biological impacts of childhood adversity: A review of intervention programs
Purewal, S. K., Au, V., Koita, K., Oh, D. L., Briner, S., Harris, N. B., & Bucci, M. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.04.014 · Cited by 99 · see citing works
Estimated Lifetime Medical and Work-Loss Costs of Fatal Injuries — United States, 2013
Florence, C., Simon, T. R., Haegerich, T. M., Luo, F., & Zhou, C. (2015) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6438a4 · Cited by 97 · see citing works
Self-citationA Developmental Psychopathology Perspective on Child Maltreatment
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Intersections of individual and neighborhood disadvantage: Implications for child maltreatment
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Risk terrain modeling predicts child maltreatment
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On the incidence and prevalence of child maltreatment: a research agenda
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A Systemic Framework for Trauma-Informed Schooling: Complex but Necessary!
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Primary and secondary prevention of child sexual abuse
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“There are also financial consequences, as it has been estimated that the annual cost of CSA (without attempting to account for the cost of harming a child) is USD$124 billion in the United States (Fang et al., 2012), AUD$3.”
BackgroundFlorence, C., Haegerich, T. M., Simon, T. R., Zhou, C., & Luo, F. (2015) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6438a5 · Cited by 90 · see citing works
Self-citationPan, Y., Lin, X., Liu, J., Zhang, S., Zeng, X., Chen, F., & Wu, J. (2020) · Trauma Violence & Abuse · doi:10.1177/1524838020912867 · Cited by 88 · see citing works
“The lifelong economic burden of CSA results from mental and physical diseases, reduced health-related quality of life, and impaired earning capacity as adults (Fang et al., 2012; Fang, Fry, Brown, et al., 2015).”
Background
- Authors
- Fang, X., Brown, D. S., Florence, C. S., & Mercy, J. A.
- Affiliations
- Centers for Disease Control and Prevention (US)
- RTI International (US)
- Corresponding author
- Fang, Xiangming
- Venue
- Child Abuse & Neglect
- Publisher
- Elsevier BV
- Published
- 2012-02
- Volume
- 36
- Issue
- 2
- Pages
- 156-165
- ISSN
- 0145-2134 (ISSN-L)
- PMC
- PMC3776454
- OpenAlex
- W2167783241
- Cited by
- 1,122
- References
- 62
- Citations by year
- 2026: 30 · 2025: 41 · 2024: 47 · 2023: 65 · 2022: 95 · 2021: 75 · 2020: 111 · 2019: 91 · 2018: 111 · 2017: 112 · 2016: 101 · 2015: 100 · 2014: 69 · 2013: 52 · 2012: 16
- FWCI
- 86.20
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Child Abuse & Neglect (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Centers for Disease Control and Prevention (200-2008-M-28149)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child Abuse and Related Trauma
- Keywords
- child abuse, economic burden, lifetime costs, child abuse prevention, productivity loss, criminal justice costs, special education costs, cost estimation
- MeSH terms
- Adolescent, Adult, Child, Child Abuse, Child, Preschool, Costs and Cost Analysis, Female, Humans, Infant, Male, Middle Aged, United States, Health Care Costs, Young Adult
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