Græsholt-Knudsen Troels, Rask Charlotte Ulrikka, Lucas Steven, Bech Bodil Hammer
Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
Eur J Pediatr. 2024 Feb;183(2):663-675. doi: 10.1007/s00431-023-05317-1. Epub 2023 Nov 13.
Improved prediction of physical child abuse could aid in developing preventive measures. Parental physical disease has been tested previously as a predictor of documented physical child abuse but in broad categories and with differing results. No prior studies have tested clinically recognizable categories of parental disease in a high-powered dataset. Using Danish registries, data on children and their parents from the years 1997-2018 were used to explore several parental physical disease categories' associations with documented physical child abuse. For each disease category, survival analysis using pseudovalues was applied. When a parent of a child was diagnosed or received medication that qualified for a category, this family and five comparison families not in this disease category were included, creating separate cohorts for each category of disease. Multiple analyses used samples drawn from 2,705,770 children. Estimates were produced for 32 categories of physical diseases. Using Bonferroni-corrected confidence intervals (CIc), ischemic heart disease showed a relative risk (RR) of 1.44 (CIc 1.13-1.84); peripheral artery occlusive disease, RR 1.39 (CIc 1.01-1.90); stroke, RR 1.19 (1.01-1.41); chronic pulmonary disease, RR 1.33 (CIc 1.18-1.51); ulcer/chronic gastritis, RR 1.27 (CIc 1.08-1.49); painful condition, 1.17 (CIc 1.00-1.37); epilepsy, RR 1.24 (CIc 1.00-1.52); and unspecific somatic symptoms, RR 1.37 (CIc 1.21-1.55). Unspecific somatic symptoms were present in 71.87% of families at some point during the study period.
Most parental physical disease categories did not show statistically significant associations, but some showed predictive ability. Further research is needed to explore preventive potential.
• Few and broad categories of parental physical disease have been examined as risk factors for severe physical child abuse; no prior study has used several categories as predictors.
• Unspecific symptoms, ischemic heart disease, peripheral artery occlusive disease, stroke, chronic pulmonary disease, stomach ulcer/chronic gastritis, painful condition, and epilepsy all showed to be potential predictors, with unspecific symptoms being the most prevalent.
改善对儿童身体虐待的预测有助于制定预防措施。先前已将父母身体疾病作为已记录的儿童身体虐待的预测因素进行了测试,但分类宽泛且结果各异。此前尚无研究在高功率数据集中测试临床上可识别的父母疾病类别。利用丹麦登记处的数据,使用1997年至2018年期间儿童及其父母的数据,探讨几种父母身体疾病类别与已记录的儿童身体虐待之间的关联。对于每个疾病类别,应用了使用伪值的生存分析。当孩子的父母被诊断出患有或接受符合某一类别标准的药物治疗时,该家庭以及五个不属于该疾病类别的对照家庭被纳入,为每个疾病类别创建单独的队列。多次分析使用了从2705770名儿童中抽取的样本。对32种身体疾病类别进行了估计。使用经邦费罗尼校正的置信区间(CIc),缺血性心脏病的相对风险(RR)为1.44(CIc 1.13 - 1.84);外周动脉闭塞性疾病,RR为1.39(CIc 1.01 - 1.90);中风,RR为1.19(1.01 - 1.41);慢性肺病,RR为1.33(CIc 1.18 - 1.51);溃疡/慢性胃炎,RR为1.27(CIc 1.08 - 1.49);疼痛状况,1.17(CIc 1.00 - 1.37);癫痫,RR为1.24(CIc 1.00 - 1.52);以及非特异性躯体症状,RR为1.37(CIc 1.21 - 1.55)。在研究期间的某个时间点,71.87%的家庭存在非特异性躯体症状。
大多数父母身体疾病类别未显示出统计学上的显著关联,但有些显示出预测能力。需要进一步研究以探索预防潜力。
• 很少有宽泛的父母身体疾病类别被作为严重儿童身体虐待的风险因素进行研究;此前没有研究将几种类别用作预测因素。
• 非特异性症状、缺血性心脏病、外周动脉闭塞性疾病、中风、慢性肺病、胃溃疡/慢性胃炎、疼痛状况和癫痫均显示为潜在预测因素,其中非特异性症状最为普遍。