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The economic burden of child maltreatment in the United States and implications for prevention
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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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“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
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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
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
“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
Long-Term Impact of Childhood Abuse and Neglect on Crime and Violence
Widom, C. S. (2017) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12194 · Cited by 175
Bellis, M. A., Hughes, K. E., Hardcastle, K., Ashton, K., Ford, K., Quigg, Z., & Davies, A. R. (2017) · Journal of Health Services Research & Policy · doi:10.1177/1355819617706720 · Cited by 106
“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 110
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
Self-citationSprang, G., & Cole, J. (2018) · Journal of Family Violence · doi:10.1007/s10896-018-9950-y · Cited by 103
“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 122
Benson, M. S., & Powell, M. B. (2015) · Psychology Public Policy and Law · doi:10.1037/law0000052 · Cited by 98
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
“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
“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 116
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 107
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
Self-citationA Developmental Psychopathology Perspective on Child Maltreatment
Cicchetti, D., & Banny, A. M. (2014) · Springer eBooks · doi:10.1007/978-1-4614-9608-3_37 · Cited by 105
van Der Kolk, B., Ford, J. D., & Spinazzola, J. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1562841 · Cited by 108
Intersections of individual and neighborhood disadvantage: Implications for child maltreatment
Maguire‐Jack, K., & Font, S. A. (2016) · Children and Youth Services Review · doi:10.1016/j.childyouth.2016.10.015 · Cited by 96
David Finkelhor, B., Turner, H. A., Shattuck, A., Hamby, S. L., & Kracke, K. (2015) · Cited by 97
Green, B. L., AYOUB, C. C., Bartlett, J. D., Ende, A. V., Furrer, C. J., Chazan‐Cohen, R., Vallotton, C. D., & Klevens, J. (2014) · Children and Youth Services Review · doi:10.1016/j.childyouth.2014.03.044 · Cited by 95
Risk terrain modeling predicts child maltreatment
Daley, D., Bachmann, M., Bachmann, B. A., Pedigo, C., Bui, M.-T., & Coffman, J. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2016.09.014 · Cited by 97
On the incidence and prevalence of child maltreatment: a research agenda
Jud, A., Fegert, J. M., & David Finkelhor, B. (2016) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-016-0105-8 · Cited by 94
Lang, J. M., & Connell, C. M. (2017) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000235 · Cited by 102
A Systemic Framework for Trauma-Informed Schooling: Complex but Necessary!
Howard, J. A. (2018) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2018.1479323 · Cited by 92
Primary and secondary prevention of child sexual abuse
Knack, N., Winder, B., Murphy, L., & Fedoroff, J. P. (2019) · International Review of Psychiatry · doi:10.1080/09540261.2018.1541872 · Cited by 96
“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
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
“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
Metadata
- 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 › Sociology and Political Science › 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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