Community poverty and child abuse fatalities in the United States
Abstract
BACKGROUND AND OBJECTIVE: Child maltreatment remains a problem in the United States, and individual poverty is a recognized risk factor for abuse. Children in impoverished communities are at risk for negative health outcomes, but the relationship of community poverty to child abuse fatalities is not known. Our objective was to evaluate the association between county poverty concentration and rates of fatal child abuse. METHODS: This was a retrospective, cross-sectional analysis of child abuse fatalities in US children 0 to 4 years of age from 1999 to 2014 by using the Centers for Disease Control and Prevention Compressed Mortality Files. Population and poverty statistics were obtained from US Census data. National child abuse fatality rates were calculated for each category of community poverty concentration. Multivariate negative binomial regression modeling assessed the relationship between county poverty concentration and child abuse fatalities. RESULTS: From 1999 to 2014, 11 149 children 0 to 4 years old died of child abuse; 45% (5053) were <1 year old, 56% (6283) were boys, and 58% (6480) were white. The overall rate of fatal child abuse was 3.5 per 100 000 children 0 to 4 years old. In the multivariate model, counties with the highest poverty concentration had >3 times the rate of child abuse fatalities compared with counties with the lowest poverty concentration (adjusted incidence rate ratio, 3.03; 95% confidence interval, 2.4-3.79). CONCLUSIONS: Higher county poverty concentration is associated with increased rates of child abuse fatalities. This finding should inform public health officials in targeting high-risk areas for interventions and resources.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Social and structural inequities such as poverty are linked with increased risk of fatal physical abuse in children of color.
“Further, research has linked social and structural inequities (e.g., poverty) with increased risk of fatal PA in children of color (Farrell et al., 2017).”
From Child abuse-related homicides precipitated by caregiver use of harsh physical punishment (2023) · cites this paper as Farrell et al., 2017
Children who reside in households with an unrelated adult are at greater risk of being victims of non-fatal and fatal physical abuse.
“For example, studies have shown children who are young; male; Black, non-Hispanic; have a history of abuse or previous non-fatal injury; and reside in households with an unrelated adult, are at greater risk of being victims of non-fatal and fatal PA (Daly & Wilson, 1994;Farrell et al., 2017;Fortson, Klevens, Merrick, Gilbert, & Alexander, 2016;Pierce et al., 2017;Putnam-Hornstein, Cleves, Licht, &”
From Child abuse-related homicides precipitated by caregiver use of harsh physical punishment (2023) · cites this paper as Farrell et al., 2017
Children with a history of abuse or previous non-fatal injury are at greater risk of being victims of non-fatal and fatal physical abuse.
“For example, studies have shown children who are young; male; Black, non-Hispanic; have a history of abuse or previous non-fatal injury; and reside in households with an unrelated adult, are at greater risk of being victims of non-fatal and fatal PA (Daly & Wilson, 1994;Farrell et al., 2017;Fortson, Klevens, Merrick, Gilbert, & Alexander, 2016;Pierce et al., 2017;Putnam-Hornstein, Cleves, Licht, &”
From Child abuse-related homicides precipitated by caregiver use of harsh physical punishment (2023) · cites this paper as Farrell et al., 2017
Black children aged 0-4 years living in communities with the lowest poverty concentration had a rate of fatal child abuse 1.6 times that of White children of the same age living in communities with the highest poverty concentration.
“One study found Black children aged 0-4 years living in communities with the lowest poverty concentration had a rate of fatal child abuse 1.6 times (5.1 per 100,000 children 0-4 years old) that of White children of the same age who were living in communities with the highest poverty concentration (3.2 per 100,000 children 0-4 years old; Farrell et al., 2017).”
From Child abuse-related homicides precipitated by caregiver use of harsh physical punishment (2023) · cites this paper as Farrell et al., 2017
Cites
Association of Child Poverty, Brain Development, and Academic Achievement
Hair, N. L., Hanson, J. L., Wolfe, B. L., & Pollak, S. D. (2015) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2015.1475 · Cited by 1,016 · see citing works
U.S. Government Accountability Office
(2013) · Choice Reviews Online · doi:10.5860/choice.50-5961 · Cited by 997 · see citing works
Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress
Sedlak, A. J. (2010) · PsycEXTRA Dataset · Cited by 963 · see citing works
Hussey, J. M., Chang, J. J., & Kotch, J. (2006) · Pediatrics · doi:10.1542/peds.2005-2452 · Cited by 895 · see citing works
Poverty and Child Health in the United States
Gitterman, B. A., Flanagan, P., Cotton, W. H., Dilley, K. J., Duffee, J. H., Green, A. E., Keane, V. A., Krugman, S., Linton, J. M., McKelvey, C. D., et al. (2016) · PEDIATRICS · doi:10.1542/peds.2016-0339 · Cited by 771 · see citing works
How neighborhoods influence child maltreatment: A review of the literature and alternative pathways
Coulton, C. J., Crampton, D., Irwin, M., Spilsbury, J. C., & Korbin, J. E. (2007) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2007.03.023 · Cited by 730 · see citing works
Krieger, N., Chen, J. T., Waterman, P. D., Soobader, M.-J., Subramanian, S. V., & Carson, R. (2003) · Journal of Epidemiology & Community Health · doi:10.1136/jech.57.3.186 · Cited by 601 · see citing works
Understanding the relationship between neighborhood poverty and specific types of child maltreatment
Drake, B., & Pandey, S. (1996) · Child Abuse & Neglect · doi:10.1016/0145-2134(96)00091-9 · Cited by 581 · see citing works
Putnam‐Hornstein, E., Needell, B., King, B., & Johnson‐Motoyama, M. (2013) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2012.08.005 · Cited by 493 · see citing works
The Prevalence of Confirmed Maltreatment Among US Children, 2004 to 2011
Wildeman, C., Emanuel, N., Leventhal, J. M., Putnam‐Hornstein, E., Waldfogel, J., & Lee, H. E. (2014) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2014.410 · Cited by 488 · see citing works
Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis.
O'Campo, P. J., Xue, X., Wang, M. C., & Caughy, M. O. (1997) · American Journal of Public Health · doi:10.2105/ajph.87.7.1113 · Cited by 462 · see citing works
Racial Differences in the Evaluation of Pediatric Fractures for Physical Abuse
Lane, W. G. (2002) · JAMA · doi:10.1001/jama.288.13.1603 · Cited by 419 · see citing works
Child maltreatment as a community problem
Garbarino, J., & Kostelny, K. (1992) · Child Abuse & Neglect · doi:10.1016/0145-2134(92)90062-v · Cited by 380 · see citing works
Racial Bias in Child Protection? A Comparison of Competing Explanations Using National Data
Drake, B., Jolley, J. M., Lanier, P., Fluke, J., Barth, R. P., & Jonson‐Reid, M. (2011) · PEDIATRICS · doi:10.1542/peds.2010-1710 · Cited by 370 · see citing works
Child abuse incidence and reporting by hospitals: significance of severity, class, and race.
Hampton, R. L., & Newberger, E. H. (1985) · American Journal of Public Health · doi:10.2105/ajph.75.1.56 · Cited by 315 · see citing works
Krieger, N. R., Waterman, P. D., Chen, J. T., et al. (2003) · Public Health Reports · doi:10.1093/phr/118.3.240 · Cited by 278 · see citing works
Income Inequality and Child Maltreatment in the United States
Eckenrode, J. J., Smith, E. G., McCarthy, M. E., & Dineen, M. (2014) · PEDIATRICS · doi:10.1542/peds.2013-1707 · Cited by 276 · see citing works
Evaluation of Suspected Child Physical Abuse
Kellogg, N. D. (2007) · PEDIATRICS · doi:10.1542/peds.2007-0883 · Cited by 269 · see citing works
Grady, S. C. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.08.017 · Cited by 238 · see citing works
Recommended Framework for Presenting Injury Mortality Data
(1997) · PsycEXTRA Dataset · doi:10.1037/e547412006-001 · Cited by 225 · see citing works
Kotch, J. B., Browne, D. C., Dufort, V., Winsor, J., & Catellier, D. (1999) · Child Abuse & Neglect · doi:10.1016/s0145-2134(99)00003-4 · Cited by 222 · see citing works
Race, Ethnicity, and Socioeconomic Status in Research on Child Health
Cheng, T. L., & Goodman, E. (2015) · Pediatrics · doi:10.1542/peds.2014-3109 · Cited by 202 · see citing works
Impoverishment and child maltreatment in African American and European American neighborhoods
Korbin, J. E., Coulton, C. J., Chard, S. E., Platt-Houston, C., & Su, M. (1998) · Development and Psychopathology · doi:10.1017/s0954579498001588 · Cited by 182 · see citing works
Examining racial disproportionality in child protective services case decisions
Font, S. A., Berger, L. M., & Slack, K. S. (2012) · Children and Youth Services Review · doi:10.1016/j.childyouth.2012.07.012 · Cited by 137 · see citing works
Socioeconomic and Racial/Ethnic Disparities in the Incidence of Bacteremic Pneumonia Among US Adults
Burton, D. C., Flannery, B. L., Bennett, N. M., et al. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.181313 · Cited by 135 · see citing works
Local Macroeconomic Trends and Hospital Admissions for Child Abuse, 2000–2009
Wood, J. N., Medina, S. P., Feudtner, C., Luan, X., Localio, R. A., Fieldston, E. S., & Rubin, D. M. (2012) · PEDIATRICS · doi:10.1542/peds.2011-3755 · Cited by 131 · see citing works
Using US Data to Estimate the Incidence of Serious Physical Abuse in Children
Leventhal, J. M., Martin, K. D., & Gaither, J. R. (2012) · PEDIATRICS · doi:10.1542/peds.2011-1277 · Cited by 129 · see citing works
Risk Factors for Child and Adolescent Maltreatment
Mersky, J. P., Berger, L. M., Reynolds, A. J., & Gromoske, A. N. (2008) · Child Maltreatment · doi:10.1177/1077559508318399 · Cited by 128 · see citing works
Freisthler, B., & Maguire‐Jack, K. (2015) · Child Maltreatment · doi:10.1177/1077559515598000 · Cited by 121 · see citing works
Bhattacharyya, N., & Shapiro, N. L. (2014) · Otolaryngology · doi:10.1177/0194599814552647 · Cited by 108 · see citing works
Increased incidence of nonaccidental head trauma in infants associated with the economic recession
Huang, M. I., O’Riordan, M. A., Fitzenrider, E., et al. (2011) · Journal of Neurosurgery Pediatrics · doi:10.3171/2011.5.peds1139 · Cited by 89 · see citing works
Cause of Death Affects Racial Classification on Death Certificates
Noymer, A., Penner, A. M., & Saperstein, A. (2011) · PLoS ONE · doi:10.1371/journal.pone.0015812 · Cited by 76 · see citing works
Incidence of Serious Injuries Due to Physical Abuse in the United States: 1997 to 2009
Leventhal, J. M., & Gaither, J. R. (2012) · PEDIATRICS · doi:10.1542/peds.2012-0922 · Cited by 72 · see citing works
Karb, R. A., Subramanian, S. V., & Fleegler, E. W. (2016) · PLoS ONE · doi:10.1371/journal.pone.0153516 · Cited by 67 · see citing works
Self-citationEpidemiology of abusive abdominal trauma hospitalizations in United States children
Lane, W. G., Dubowitz, H., LANGENBERG, P. W., & Dischinger, P. C. (2012) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2011.09.010 · Cited by 61 · see citing works
Community characteristics associated with child abuse in Iowa
Weissman, A. M., Jogerst, G. J., & Dawson, J. D. (2003) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2003.09.002 · Cited by 58 · see citing works
Children and US Federal Policy on Health and Health Care
Flores, G., & Lesley, B. (2014) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2014.1701 · Cited by 29 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Child abuse-related homicides precipitated by caregiver use of harsh physical punishment
Wilson, R. F., Afifi, T. O., Yuan, K., Lyons, B. H., Fortson, B. L., Oliver, C., Watson, A., & Self-Brown, S. (2023) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2022.105953 · Cited by 11 · see citing works
“This finding is consistent with prior research examining parental use of PP (Gershoff, 2002) and fatal child abuse (Farrell et al., 2017; Fortson et al., 2016; Putnam-Hornstein et al., 2013; Schnitzer & Ewigman, 2005).”
BackgroundResultInfluential
- Authors
- Farrell, C. A., Fleegler, E. W., Monuteaux, M. C., Wilson, C. R., Christian, C. W., & Lee, L. K.
- Affiliations
- Harvard University (US)
- Boston Children's Hospital (US)
- Children's Hospital of Philadelphia (US)
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2017-05-01
- Volume
- 139
- Issue
- 5
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2608492431
- Cited by
- 97
- References
- 37
- Citations by year
- 2025: 5 · 2024: 7 · 2023: 11 · 2022: 15 · 2021: 13 · 2020: 14 · 2019: 23 · 2018: 8 · 2017: 1
- FWCI
- 15.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child Abuse and Related Trauma
- Keywords
- community poverty, child abuse, infant mortality, socioeconomic risk factors, high-risk areas
- MeSH terms
- Cause of Death, Child Abuse, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Male, Poverty, Residence Characteristics, Retrospective Studies, Risk Factors, United States
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
