title: Disparities in child abuse mortality are not explained by injury severity.
abstract: BACKGROUND
  Unadjusted abuse-related mortality has been demonstrated to be nearly 4-fold higher for African American (AA) children. Little is known about the etiology of this disparity. This study examines the importance of injury severity and initial presentation in explaining the observed disparity.
  
  
  METHODS
  Our trauma database was reviewed to identify all abused patients admitted over a 10-year period. Outcomes among white and AA children were compared with specific attention to injury severity scores and initial presentation. Logistic regression and Cox proportional hazard analyses were performed to evaluate the impact of race on outcome.
  
  
  RESULTS
  There were 443 abused children identified. Thirty-eight percent of the group was AA. The overall mortality was 7.7%; however, the AA mortality was significantly higher than white children (14.8% vs 3.3%; P < .05). After controlling for injury severity and physiology at presentation, the odds ratio of mortality for an AA child was 9.14 (95% confidence interval, 1.97-42.43). Survival analysis confirmed the disparity after revealing a hazard ratio of dying for AA children of 6.51 (95% confidence interval, 2.74-15.47) compared with white children.
  
  
  CONCLUSIONS
  Despite attempts to control for the clinical presentation and injury severity of abused children, significant differences in mortality persist between AA and white children.
authors.affiliation: Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. richard.falcone@cchmc.org
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
authors.forename: Rebeccah L
authors.initials: RL
authors.lastname: Brown
authors.forename: Victor F
authors.initials: VF
authors.lastname: Garcia
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality; D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data*; D001794:Blood Pressure; D002648:Child; D002649:Child Abuse / Q000401:mortality*; D002675:Child, Preschool; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D006259:Craniocerebral Trauma / Q000401:mortality; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000401:mortality; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000401:mortality; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*