title: Geographic patterns of fatal abuse or neglect in children younger than 5 years old, United States, 1979 to 1988.
abstract: OBJECTIVE
  To examine geographic patterns of fatal child abuse or neglect (CAN) among children younger than 5 years old.
  
  
  METHODS
  A death certificate-based model to estimate the occurrence of fatal CAN.
  
  
  METHODS
  United States, 1979 to 1988.
  
  
  METHODS
  The population of children younger than 5 years old.
  
  
  METHODS
  None.
  
  
  RESULTS
  We estimate that from 868 to 1815 deaths annually occur among children younger than 5 years old from CAN. The lower figure is the estimate of confirmed CAN, and the higher is the estimate of the sum of confirmed, probable, and possible CAN. Death rates were highest in the South and West, intermediate in the North Central, and lowest in the Northeast. A threefold difference was noted between rates in the lowest- and highest-ranking states (ie, Connecticut, 2.9 to 5.2 per 100,000, and Nevada, 6.7 to 15.4 per 100,000, respectively). When the 39 largest metropolitan areas were ranked, a similar variation between the lowest and the highest was observed (ie, Boston, Mass, 2.7 to 5.5 per 100,000, and Phoenix, Ariz, 6.6 to 15.5 per 100,000, respectively).
  
  
  CONCLUSIONS
  Understanding the sizable geographic variation in CAN deaths rates could lead to effective interventions. If the US fatality rate were reduced to that of Connecticut, between 434 and 908 fewer CAN deaths might occur annually.
authors.affiliation: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: P W
authors.initials: PW
authors.lastname: McClain
authors.forename: J J
authors.initials: JJ
authors.lastname: Sacks
authors.forename: B G
authors.initials: BG
authors.lastname: Ewigman
authors.forename: S M
authors.initials: SM
authors.lastname: Smith
authors.forename: J A
authors.initials: JA
authors.lastname: Mercy
authors.forename: J E
authors.initials: JE
authors.lastname: Sniezek
mesh_terms: D002423:Cause of Death; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality