New study examines urban-rural residence and rates of child physical abuse hospitalizations

After adjusting for poverty, rates of child physical abuse (CPA) hospitalizations only varied for black children across the urban-rural spectrum, according to findings of a new study examining the rates of CPA hospitalizations and urban-rural status of children's county of residence. In addition, central metro counties remain important areas for prevention efforts, particularly for black children. Findings from the study will be presented during the Pediatric Academic Societies (PAS) 2018 Meeting in Toronto.

This study used the 2012 Kids' Inpatient Database and U.S. Census data. CPA hospitalizations for black, non-Hispanic white and Hispanic children <5 years of age were identified using discharge codes and categorized by the urban-rural status of children's county of residence: central metro, fringe/small metro and rural. Chi-square tests assessed for differences in CPA hospitalizations between urban-rural categories. Rates of CPA hospitalizations for the total child and race/ethnicity-stratified populations were calculated for each urban-rural category. Rates were adjusted using race/ethnicity and poverty and compared using Poisson regression.

The study found that there were 3,082 CPA hospitalizations involving children residing in central metro (32.0 percent), fringe/small metro (53.0 percent) and rural (15.0 percent) counties. Abused rural children, compared to both metro categories, were younger (p= 0.002), more likely to have public insurance (p= 0.008), live in zip codes with lower median household incomes (p< 0.001) and be victims of abusive head trauma (p< 0.001).

The unadjusted rates of CPA hospitalizations were: 16.9 per 100,000 total children, 29.3 per 100,000 black children, 15.4 per 100,000 non-Hispanic white children and 13.1 per 100,000 Hispanic children. Adjusted CPA hospitalization rates for total child populations did not vary across urban-rural categories (p= 0.63). However, the poverty-adjusted rate of CPA hospitalizations for black children decreased 34.8 percent from central metro to rural (p= 0.001). Adjusted rates of CPA hospitalizations for non-Hispanic white and Hispanic children did not vary across urban-rural categories.

Rural counties have higher child poverty and less access to social services. The limited existing literature is conflicting on how CPA rates may vary across the urban-rural spectrum. Understanding these population-level data could inform policy and CPA prevention strategies. Further study of protective and risk factors contributing to these differences may inform future policy and prevention initiatives.