Local macroeconomic trends and hospital admissions for child abuse, 2000-2009.
OBJECTIVE
To examine the relationship between local macroeconomic indicators and physical abuse admission rates to pediatric hospitals over time.


METHODS
Retrospective study of children admitted to 38 hospitals in the Pediatric Hospital Information System database. Hospital data were linked to unemployment, mortgage delinquency, and foreclosure data for the associated metropolitan statistical areas. Primary outcomes were admission rates for (1) physical abuse in children <6 years old, (2) non-birth, non-motor vehicle crash-related traumatic brain injury (TBI) in infants <1 year old (which carry high risk for abuse), and (3) all-cause injuries. Poisson fixed-effects regression estimated trends in admission rates and associations between those rates and trends in unemployment, mortgage delinquency, and foreclosure.


RESULTS
Between 2000 and 2009, rates of physical abuse and high-risk TBI admissions increased by 0.79% and 3.1% per year, respectively (P ≤ .02), whereas all-cause injury rates declined by 0.80% per year (P < .001). Abuse and high-risk TBI admission rates were associated with the current mortgage delinquency rate and with the change in delinquency and foreclosure rates from the previous year (P ≤ .03). Neither abuse nor high-risk TBI rates were associated with the current unemployment rate. The all-cause injury rate was negatively associated with unemployment, delinquency, and foreclosure rates (P ≤ .007).


CONCLUSIONS
Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends.
PolicyLab and General Pediatrics, The Children's Hospital of Philadelphia 3535 Market St, Room 1517, Philadelphia, PA 19104, USA. woodjo@email.chop.edu
Joanne N
JN
Wood
Sheyla P
SP
Medina
Chris
C
Feudtner
Xianqun
X
Luan
Russell
R
Localio
Evan S
ES
Fieldston
David M
DM
Rubin
D001930:Brain Injuries / Q000191:economics; D015984:Causality; D002649:Child Abuse / Q000191:economics*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D007223:Infant; D008297:Male; D010343:Patient Admission / Q000191:economics* / Q000639:trends; D010414:Pennsylvania; D016012:Poisson Distribution; D011203:Poverty / Q000191:economics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014478:Unemployment / Q000639:trends