Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment.

IF 10.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Fereshteh Salimi-Jazi, Norah E Liang, Zhuoyi Huang, Lakshika Tennakoon, Talha Rafeeqi, Amber Trickey, Stephanie D Chao
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引用次数: 0

Abstract

Importance: Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging.

Objective: To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury.

Design, setting, and participants: This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024.

Exposure: The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment.

Main outcome and measure: The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA.

Results: Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P < .001) for serious injury.

Conclusion and relevance: In this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.

儿童虐待识别和住院治疗的种族差异。
重要性:虐待儿童是儿童早期发病的主要原因。准确的检测仍然具有挑战性。目的:探讨创伤后住院儿童虐待嫌疑的种族和民族差异。设计、环境和参与者:这项在2022年至2024年间进行的回顾性、多中心横断面研究检查了具有代表性的全国儿童和青少年样本(年龄暴露:使用《国际疾病分类》第九版临床修改(ICD-9-CM)和《国际疾病统计分类》第十版临床修改(ICD-10-CM)对应的儿童和青少年虐待代码来确定SCA亚组。主要结局和测量:主要结局是创伤性损伤合并SCA与无SCA的儿科患者的种族和民族组成。结果:在纳入研究的634 309例数据完整的儿科患者中,有13 579例患者的损伤可归因于SCA (SCA亚组;平均[SD]年龄1.70[0.04]岁;男性7650人[56.3%];2868名黑人[21.1%],2293名西班牙裔[16.9%],5675名白人[41.8%])和620名 730名患者没有(非sca亚组;平均[SD]年龄,9.70[0.01]岁;395 158名男性[63.7%];86 376黑人[13.9%],108 406西班牙裔[17.5%],298 748白人[48.1%])。非sca亚组的种族和民族分布与2010年美国人口普查相似。在SCA亚组中,黑人患者(优势比[OR], 1.75;95% ci, 1.65-1.85;结论和相关性:在这项研究中,黑人儿童和青少年被怀疑经历过虐待的比例高于其他种族和民族背景的儿童和青少年。需要更多的研究来了解这些差异的起源,以减少儿童虐待鉴定方面的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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