title: Association of Pediatric Abusive Head Trauma Rates With Macroeconomic Indicators.
abstract: OBJECTIVE
  We aimed to examine abusive head trauma (AHT) incidence before, during and after the recession of 2007-2009 in 3 US regions and assess the association of economic measures with AHT incidence.
  
  
  METHODS
  Data for children <5 years old diagnosed with AHT between January 1, 2004, and December 31, 2012, in 3 regions were linked to county-level economic data using an ecologic time series analysis. Associations between county-level AHT rates and recession period as well as employment growth, mortgage delinquency, and foreclosure rates were examined using zero-inflated Poisson regression models.
  
  
  RESULTS
  During the 9-year period, 712 children were diagnosed with AHT. The mean rate of AHT per 100,000 child-years increased from 9.8 before the recession to 15.6 during the recession before decreasing to 12.8 after the recession. The AHT rates after the recession were higher than the rates before the recession (incidence rate ratio 1.31, P = .004) but lower than rates during the recession (incidence rate ratio 0.78, P = .005). There was no association between the AHT rate and employment growth, mortgage delinquency rates, or foreclosure rates.
  
  
  CONCLUSIONS
  In the period after the recession, AHT rate was lower than during the recession period yet higher than the level before the recession, suggesting a lingering effect of the economic stress of the recession on maltreatment risk.
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Division of PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa. Electronic address: woodjo@email.chop.edu.
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Wood
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa.
authors.forename: Janet
authors.initials: J
authors.lastname: Fromkin
authors.affiliation: Division of PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Oludolapo
authors.initials: O
authors.lastname: Fakeye
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Philip V
authors.initials: PV
authors.lastname: Scribano
authors.affiliation: Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Letson
authors.affiliation: Mayerson Center for Safe and Healthy Children and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Kathi L
authors.initials: KL
authors.lastname: Makoroff
authors.affiliation: General Pediatric Division and Children's Protection Program, Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Wash.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Feldman
authors.affiliation: Department of Epidemiology and Graduate School of Public Health, Epidemiology Data Coordinating Center.
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Rachel
authors.initials: R
authors.lastname: Berger
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000453:epidemiology*; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology; D057172:Economic Recession / Q000706:statistics & numerical data*; D004467:Economics; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: child abuse; economic recession; traumatic brain injury