title: Longitudinal association of county-level economic indicators and child maltreatment incidents.
abstract: To evaluate the association between economic indicators (unemployment and mortgage foreclosure rates) and volume of investigated and substantiated cases of child maltreatment at the county level from 1990 to 2010 in the Commonwealth of Pennsylvania. County-level investigated reports of child maltreatment and proportion of investigated cases substantiated by child protective services in the Commonwealth of Pennsylvania were compared with county-level unemployment rates from 1990 to 2010, and with county-level mortgage foreclosure rates from 2000 to 2010. We employed fixed-effects Poisson regression modeling to estimate the association between volume of investigated and substantiated cases of maltreatment, and current and prior levels of local economic indicators adjusting for temporal trend. Across Pennsylvania, annual rate of investigated maltreatment reports decreased through the 1990s and rose in the early 2000s before reaching a peak of 9.21 investigated reports per 1,000 children in 2008, during the recent economic recessionary period. The proportion of investigated cases substantiated, however, decreased statewide from 33 % in 1991 to 15 % in 2010. Within counties, current unemployment rate, and current and prior-year foreclosure rates were positively associated with volume of both investigated and substantiated child maltreatment incidents (p < 0.05). Despite recent increases in investigations, the proportion of investigated cases substantiated decreased by more than half from 1990 to 2010 in Pennsylvania. This trend suggests significant changes in substantiation standards and practices during the period of study. Economic indicators demonstrated strong association with investigated and substantiated maltreatment, underscoring the urgent need for directing important prophylactic efforts and resources to communities experiencing economic hardship.
authors.affiliation: Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Frioux
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Wood
authors.forename: Oludolapo
authors.initials: O
authors.lastname: Fakeye
authors.forename: Xianqun
authors.initials: X
authors.lastname: Luan
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.forename: David M
authors.initials: DM
authors.lastname: Rubin
mesh_terms: D002648:Child; D002649:Child Abuse / Q000191:economics* / Q000639:trends; D000068216:Child Protective Services / Q000706:statistics & numerical data*; D057172:Economic Recession; D006801:Humans; D009111:Local Government; D008137:Longitudinal Studies; D010414:Pennsylvania / Q000453:epidemiology; D016012:Poisson Distribution; D011204:Poverty Areas; D014478:Unemployment