Abusive Head Trauma During a Time of Increased Unemployment: A Multicenter Analysis

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Abusive head trauma (AHT) is the leading cause of death from child abuse. Poverty and stress are recognized risk factors for abuse. No studies to date have evaluated whether there is a relationship between the economy and rates of AHT. WHAT THIS STUDY ADDS:Results of this study demonstrate a relationship between an economic recession and the rate of AHT. Given the high morbidity and mortality rates for children with AHT, these results are highly concerning. abstract OBJECTIVE: To evaluate the rate of abusive head trauma (AHT) in 3 regions of the United States before and during an economic recession and assess whether there is a relationship between the rate of AHT and county-level unemployment rates. RESULTS: During the 5 1 ⁄ 2-year study period, a total of 422 children were diagnosed with AHT in a 74-county region. The overall rate of AHT increased from 8.9 in 100 000 (95% confidence interval [CI]: 7.8 -10.0) before the recession to 14.7 in 100 000 (95% CI: 12.5-16.9) during the recession (P Ͻ .001). There was no difference in the clinical characteristics of subjects in the prerecession versus recession period. There was no relationship between the rate of AHT and county-level unemployment rates. METHODS: CONCLUSIONS:The rate of AHT increased significantly in 3 distinct geographic regions during the 19 months of an economic recession compared with the 47 months before the recession. This finding is consistent with our understanding of the effect of stress on violence. Given the high morbidity and mortality rates for children with AHT, these results are concerning and suggest that prevention efforts might need to be increased significantly during times of economic hardship.

Trends in Hospitalization Rates and Severity of Injuries From Abuse in Young Children, 1997–2009

“…These factors may influence the types and severity of injuries among young children. 5,21,28 Second, adherence to published recommendations may be leading to identification of additional occult injuries. 30,31 Third, the threshold for admitting an injured child into the hospital may have risen over time due to forces in play by insurers to limit inpatient care by definitions of medical necessity.…”

“…4 Berger found a significant increase in incidence of abusive head trauma in a multicenter analysis from 2004 to 2009 among children younger than 5 years. 5 Parks and colleagues, using mortality reports from death certificates between 2003 and 2007, reported decreasing rates of death due to accidental head injury among children aged #5 years but constant rates of death due to abusive head trauma. 6 NCANDS reports death rates due to maltreatment among children aged #3 years of 7.…”

The Great Recession, genetic sensitivity, and maternal harsh parenting

“…Associations consistent with the family stress model have been found in many other small samples throughout the United States and Europe. Whereas most studies in this literature suffer from omitted variables bias-the effects of economic hardship are identified off differences between families who do and do not experience large economic lossesmore recent studies have reported similar findings using more exogenous measures of economic conditions, e.g., plant closings (3,4), changes in income transfer policy (5,6), and unemployment rates (7,8). We also used more exogenous measures and hypothesized that higher unemployment rates were associated with higher levels of harsh parenting.…”

Understanding why children die in high-income countries

“…125,126,127 In relation to fatal child maltreatment, a number of parental characteristics recur, including young maternal age, low level of maternal education, family size, previous abuse, unemployment, parental mental ill-health and substance misuse, domestic violence, and increased parental stress (Panel 5). [128][129] …”