Emily Putnam-Hornstein and Robyn Licht are with the School of Social Work, University of Southern California, Los Angeles. Emily Putnam-Hornstein is also with and Barbara Needell is with the California Child Welfare Indicators Project, University of California, Berkeley. Mario A. Cleves is with the Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Am J Public Health. 2013 Oct;103(10):e39-44. doi: 10.2105/AJPH.2013.301516. Epub 2013 Aug 15.
We examined variations in children's risk of an unintentional or intentional fatal injury following an allegation of physical abuse, neglect, or other maltreatment.
We linked records of 514 232 children born in California from 1999 to 2006 and referred to child protective services for maltreatment to vital birth and death data. We used multivariable Cox regression models to estimate variations in risk of fatal injury before age 5 years and modeled maltreatment allegations as time-varying covariates.
Children with a previous allegation of physical abuse sustained fatal injuries at 1.7 times the rate of children referred for neglect. Stratification by manner of injury showed that children with an allegation of physical abuse died from intentional injuries at a rate 5 times as high as that for children with an allegation of neglect, yet faced a significantly lower risk of unintentional fatal injury.
These data suggest conceptual differences between physical abuse and neglect. Findings indicate that interventions consistent with the form of alleged maltreatment may be appropriate, and heightened monitoring of young children referred for physical abuse may advance child protection.
我们研究了儿童在遭受身体虐待、忽视或其他虐待指控后，意外或故意致死伤害风险的变化。
我们将加利福尼亚州 1999 年至 2006 年间出生的 514232 名儿童的记录与生命和死亡数据相关联，并将其转介给儿童保护服务机构，以进行虐待指控。我们使用多变量 Cox 回归模型来估计 5 岁之前致命伤害的风险变化，并将虐待指控建模为随时间变化的协变量。
有先前身体虐待指控的儿童致命伤害的发生率是被忽视儿童的 1.7 倍。按伤害方式分层显示，遭受身体虐待指控的儿童因故意伤害而死亡的比率是遭受忽视指控的儿童的 5 倍，但意外致命伤害的风险显著降低。
这些数据表明身体虐待和忽视之间存在概念上的差异。研究结果表明，与指控的虐待形式一致的干预措施可能是合适的，对因身体虐待而被转介的幼儿进行更密切的监测可能会促进儿童保护。
