The recession has taken a harsh toll on some of the nation's youngest citizens, with increases in child abuse severe enough to require hospitalization occurring in tandem with a rise in local mortgage foreclosures, according to a new study involving data from 38 children's hospitals.
Researchers from the Children's Hospital of Philadelphia noted a strong relationship between the abuse and mortgage woes in a study published online this week in the journal Pediatrics. It will appear in the August print edition.
"We were concerned that health care providers and child welfare workers anecdotally reported seeing more severe child physical abuse cases, yet national child protective services data indicated a downward trend," said lead author Dr. Joanne Wood, an attending physician at the children's hospital and researcher at PolicyLab, in a written statement accompanying the study. "It's well-known that economic stress has been linked to an increase in child physical abuse, so we wanted to get to the bottom of the contrasting reports by formally studying hospital data on a larger scale."
Physical abuse overall rose by .79 percent, while traumatic brain injury rose 3 percent a year between 2000 and 2009, according to the study. Overall injury rates fell by .8 percent a year over the same time period. According to the research, each 1-percent increase in 90-day mortgage delinquencies over a one-year period was associated with a 3-percent increase in hospital admissions due to child physical abuse and a 5-percent increase in admissions because of traumatic brain injuries believed to result from child abuse.
Neither abuse nor high-risk traumatic brain injuries were associated with unemployment, the study said.
In study background information, the researchers pointed out that child abuse had been trending downward in the 1990s and early in the 2000s. It suggested that positive trend was quite likely driven by a healthy economy. When the recession hit, the trend reversed.
It's not the only study to make that suggestion. According to Serena Gordon of HealthDay: "Other recent research, however, has suggested that the rates of child abuse are rising. One study published in the October 2011 issue of Pediatrics found that the rates of abusive head trauma in children went from nine per 100,000 children to 15 per 100,000 children between 2004 and 2009. A second study, presented at the American Association of Neurological Surgeons meeting in April 2011, found that the rates of abusive head trauma during the recession had doubled in children 2 years old and younger."
Wood said the new study points to a "clear opportunity to use hospital data along with child welfare data to ensure a more complete picture of child abuse rates both locally and nationally." And it identifies mortgage foreclosures as another economic woe linked to child abuse.
"As the foreclosure crisis is projected to continue in the near future, these results highlight the need to better understand the stress that housing insecurity places on families and communities so that we can better support them during difficult times," she said.
The U.S. Department of Health and Human Services has long said that children who are abused are more likely to require safety-net programs. "The social and economic costs of child abuse and neglect are difficult to calculate. Some costs are straightforward and directly related to maltreatment, such as hospital costs for medical treatment of injuries sustained as a result of physical abuse and foster-care costs resulting from the removal of children when they cannot remain safely with their families. Other costs, less directly tied to the incidence of abuse, include lower academic achievement, adult criminality and lifelong mental health problems. Both direct and indirect costs impact our society and economy."
This study follows on earlier research in 2010 by the University of Pittsburgh School of Medicine that found abuse-caused head traumas in infants and young children increased steeply since the start of the recession.
"A study like this cannot tell us what stressors may be impacting an individual family, but can illustrate the toll that the recent recession may be having on families in general in this country," said Dr. David Rubin, a senior author of the new study, in a written statement. "It is a reminder to me that when I see families in my practice who have lost their insurance or who have changed homes, to probe a little further about the challenges they are facing. As communities, we all need to reach out a little more to identify which families may be in crisis and help guide them to appropriate resources for support."
Local Macroeconomic Trends and Hospital Admissions for Child Abuse, 2000–2009
aPolicyLab and General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
bLeonard Davis Institute of Health Economics, and
Departments of cPediatrics and
dBiostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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.