Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
J Pediatr. 2019 Feb;205:230-235.e2. doi: 10.1016/j.jpeds.2018.09.071. Epub 2018 Nov 2.
To determine if child physical abuse hospitalization rates vary across urban-rural regions overall and after accounting for race/ethnicity and poverty demographics.
This was a retrospective cross-sectional study of black, Hispanic, and non-Hispanic white children <5 years of age living in all US counties. US counties were classified as central metro, fringe/small metro, and rural. Incidence rates were calculated using child physical abuse hospitalization counts from the 2012 Kids' Inpatient Database and population statistics from the 2012 American Community Survey. Counties' race/ethnicity demographics and percent of children living in poverty were used to adjust rates.
We identified 3082 child physical abuse hospitalizations occurring among 18.2 million children. Neither crude nor adjusted overall rates of child physical abuse hospitalizations varied significantly across the urban-rural spectrum. When stratified by race/ethnicity, crude child physical abuse hospitalization rates decreased among black children 29.1% (P = .004) and increased among white children 25.6% (P = .001) from central metro to rural counties. After adjusting for poverty, only rates among black children continued to vary significantly, decreasing 34.8% (P = .001) from central metro to rural counties. Rates were disproportionately higher among black children compared with white children and their disproportionality increased with population density, even after poverty adjustment. Rates among Hispanic children were disproportionately lower compared with white children in nearly all urban-rural categories.
Our results suggest that urban black children have unique exposures, outside of poverty, increasing their risk for child physical abuse hospitalization. Identifying and addressing these unique urban exposures may aid in reducing black-white disproportionalities in child physical abuse.
确定儿童身体虐待住院率是否因城乡地区不同而有所差异，以及在考虑种族/民族和贫困人口统计学因素后是否存在差异。
这是一项回顾性的横断研究，研究对象为居住在美国所有县的 5 岁以下黑种人、西班牙裔和非西班牙裔白人儿童。美国各县分为中心都会区、边缘/小都会区和农村。使用 2012 年《儿童住院数据库》中的儿童身体虐待住院人数和 2012 年《美国社区调查》中的人口统计数据计算发病率。使用各县的种族/民族人口统计学数据和生活在贫困中的儿童比例来调整发病率。
我们确定了 3082 例儿童身体虐待住院病例，涉及 1820 万儿童。无论是原始的还是调整后的儿童身体虐待住院率，在城乡之间都没有明显差异。按种族/民族分层，黑人儿童的原始儿童身体虐待住院率从中心都会区下降了 29.1%（P = .004），而白人儿童的住院率则从中心都会区上升了 25.6%（P = .001）。在调整贫困因素后，只有黑人儿童的住院率仍有显著差异，从中心都会区到农村县下降了 34.8%（P = .001）。与白人儿童相比，黑人儿童的比例过高，而且即使在调整贫困因素后，这种比例随着人口密度的增加而增加。与白人儿童相比，西班牙裔儿童的比例在几乎所有城乡类别中都过低。
我们的研究结果表明，城市中的黑人儿童存在独特的暴露风险，这些风险超出了贫困因素，增加了他们遭受儿童身体虐待住院的风险。识别和解决这些独特的城市暴露风险可能有助于减少儿童身体虐待中黑人和白人之间的不成比例现象。
