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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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“Such conditions exact costs in excess of $124 billion through suffering, disability, treatment, and loss of productivity over the lifespan (Fang et al., 2012).”
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Self-citationMapping child maltreatment risk: a 12-year spatio-temporal analysis of neighborhood influences
Enrique Gracia, A., López‐Quílez, A., Marco, M., & Lila, M. (2017) · International Journal of Health Geographics · doi:10.1186/s12942-017-0111-y · Cited by 48
Kuhlman, K. R., Robles, T. F., Bower, J. E., & Carroll, J. (2018) · Journal of Behavioral Medicine · doi:10.1007/s10865-018-9921-z · Cited by 54
“…is a robust predictor of mental and physical illness across the lifespan (Dube et al., 2003; Felitti et al., 1998), is associated with greater annual healthcare costs in adulthood (Bonomi et al., 2008; Fang et al., 2012), and has even been linked to earlier all-cause mortality (Chen et al., 2016).”
Schurer, S., Trajkovski, K., & Hariharan, T. (2019) · Labour Economics · doi:10.1016/j.labeco.2019.06.007 · Cited by 53
“A few recent economic evaluations calculated that non-fatal child maltreatment has an estimated average lifetime cost of US$210,012 per victim in the US (Fang et al. 2012); of £89,390 (US$127,000) in the UK (Conti et al.”
BackgroundJoshi, D., Raina, P. S., Tonmyr, L., MacMillan, H. L., & González, A. (2021) · CMAJ Open · doi:10.9778/cmajo.20200064 · Cited by 47
Preventing Maltreatment with a Community-Based Implementation of Parent–Child Interaction Therapy
Lanier, P., Kohl, P. L., Benz, J., Swinger, D., & Drake, B. (2012) · Journal of Child and Family Studies · doi:10.1007/s10826-012-9708-8 · Cited by 47
“The lifetime economic burden for just 1 year of confirmed cases of maltreatment is estimated to be $124 billion, or over $200,000 per child survivor (Fang et al. 2012).”
Gesundheitliche Langzeitfolgen psychosozialer Belastungen in der Kindheit – ein Update
Egle, U. T., Franz, M., Joraschky, P., Lampe, A., Seiffge‐Krenke, I., & Cierpka, M. (2016) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-016-2421-9 · Cited by 57
Development of an electronic medical record–based child physical abuse alert system
Berger, R. P., Saladino, R. A., Fromkin, J. B., Heineman, E., Suresh, S., & McGinn, T. (2017) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocx063 · Cited by 47
“2 million for each fatality.(9) The American Academy of Pediatrics (AAP) has evidence-based recommendations for which children should be screened for physical abuse and which tests should be done as part of that screening process.”
BackgroundDebowska, A., Boduszek, D., Sherretts, N., Willmott, D., & Jones, A. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.02.018 · Cited by 47
Zheng, X., Fang, Z., Shangguan, S., & Fang, X. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105162 · Cited by 48
Self-citationThe Healthy Immigrant Paradox and Child Maltreatment: A Systematic Review
Millett, L. S. (2016) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-016-0373-7 · Cited by 46
Understanding child protection decisions involving parents with mental illness and substance abuse
Roscoe, J. N., Lery, B., & Chambers, J. E. (2018) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2018.05.005 · Cited by 46
Baker, A. J. L., LeBlanc, S. S., Adebayo, T., & Mathews, B. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.104932 · Cited by 61
Herrenkohl, T. I., Klika, J. B., Brown, E. C., Herrenkohl, R. C., & Leeb, R. T. (2013) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2013.04.009 · Cited by 45
“[2] estimated the lifetime cost of nonfatal child maltreatment incidents at over $210,000 per victim.”
Fraser, J. G., Lloyd, S., Murphy, R., Crowson, M. M., Zolotor, A. J., Coker‐Schwimmer, E., & Viswanathan, M. (2013) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e31828a7dfc · Cited by 49
Universal Mandatory Reporting Policies and the Odds of Identifying Child Physical Abuse
Ho, G. W. K., Gross, D. A., & Bettencourt, A. F. (2017) · American Journal of Public Health · doi:10.2105/ajph.2017.303667 · Cited by 45
“A recent economic evaluation estimated that the average per-victim lifetime cost of child maltreatment in the United States was $210 012 for nonfatal maltreatment and $1 272 900 for fatal maltreatment.(8) Given the pervasiveness of child maltreatment, its toll on human suffering, and the enormous costs to children, fa…”
BackgroundTrauma Screening in Child Welfare: Lessons Learned from Five States
Lang, J. M., Ake, G. S., Barto, B., Caringi, J. C., Little, C., Baldwin, M. J., Sullivan, K. M., Tunno, A. M., Bodian, R., Stewart, C. J., et al. (2017) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-017-0155-y · Cited by 44
What are the costs of violence?
Hoeffler, A. (2017) · Politics Philosophy & Economics · doi:10.1177/1470594x17714270 · Cited by 44
“Fang et al. (2012) estimate the lifetime cost per victim of non-fatal child abuse in the US at around $98,000 to $210,000.(10) In contrast to the cost estimates of violence used in this study, their estimate is mainly based on tangible costs, for example, court costs, child welfare costs and discounted future earnings…”
BackgroundMethodInfluentialThe role of cortisol and psychopathy in the cycle of violence
Gowin, J. L., Green, C. E., Alcorn, J. L., Swann, A. C., Moeller, F. G., & Lane, S. D. (2013) · Psychopharmacology · doi:10.1007/s00213-013-2992-1 · Cited by 43
“In the USA, the lifetime cost of abuse and neglect, including health care, foster programs and criminal investigations, is estimated at US$210,012 per abuse victim (Fang et al. 2012).”
Augustyn, M. B., Thornberry, T. P., & Henry, K. L. (2019) · Development and Psychopathology · doi:10.1017/s0954579418001633 · Cited by 42
School personnel and child abuse and neglect reporting behavior: An integrative review
Alazri, Z., & Hanna, K. M. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.104892 · Cited by 48
Childhood abuse and suicidal ideation in a cohort of pregnant Peruvian women
Zhong, Q., Wells, A. M., Rondón, M. B., Williams, M. A., Barrios, Y. V., Sánchez, S. E., & Gelaye, B. (2016) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2016.04.052 · Cited by 45
Foster care and the earned income tax credit
Biehl, A. M., & Hill, B. C. (2017) · Review of Economics of the Household · doi:10.1007/s11150-017-9381-1 · Cited by 43
Moon, D. J., Damman, J. L., & Romero, A. G. (2018) · Trauma Violence & Abuse · doi:10.1177/1524838018774424 · Cited by 50
Infant skull fractures: Accident or abuse?
Li, X., Sandler, H., & Kleiven, S. (2018) · Forensic Science International · doi:10.1016/j.forsciint.2018.11.008 · Cited by 43
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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