title: Is underimmunization associated with child maltreatment?
abstract: OBJECTIVE
  To assess the relationship between underimmunization and child maltreatment among children referred to a child advocacy center for a child maltreatment evaluation.
  
  
  METHODS
  We conducted a secondary data analysis of 399 children aged 3 to 48 months who were referred to a child advocacy center at an academic medical center. The primary independent variable was age-appropriate immunization status. The dependent variable was maltreatment (confirmed, suspected, or ruled out). Multivariate models were used to control for insurance, race/ethnicity, and maternal education.
  
  
  RESULTS
  At 3 and 7 months of age, underimmunized children were significantly more likely to have confirmed maltreatment than children whose immunizations were up to date (at 3 months, 32.0% vs 17.6%, P < .05; at 7 months, 23.7% vs 8.6%, P < .01). At 19 months, rates were not significantly different (16.1% vs 24.1%, P = .33). In multivariate analyses, children underimmunized at 3 or 7 months of age were 4 times more likely to have confirmed maltreatment compared with children whose immunizations were up to date (at 3 months, adjusted odds ratio [AOR], 3.97, 95% confidence interval [95% CI], 1.67-9.49; at 7 months, AOR, 4.79, 95% CI, 1.47-15.66). This relationship was statistically significant for children evaluated for physical abuse (AOR, 4.34, 95% CI, 1.18-16.02), but not for sexual abuse.
  
  
  CONCLUSIONS
  Underimmunization at 3 and 7 months of age was associated with confirmed maltreatment, specifically physical abuse, in children evaluated for child maltreatment. The association between underimmunization and child abuse in the general population deserves further study.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. mss2112@columbia.edu
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Stockwell
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Brown
authors.forename: Shaofu
authors.initials: S
authors.lastname: Chen
authors.forename: Roger D
authors.initials: RD
authors.lastname: Vaughan
authors.forename: Matilde
authors.initials: M
authors.lastname: Irigoyen
mesh_terms: D002649:Child Abuse; D002651:Child Advocacy; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors