PC2041: Racial Disparities in Child Abuse Identification and Management: A Nationwide Analysis

Background: Non-accidental trauma is a leading cause of injury and death in early childhood. However, accurate detection remains challenging. The study sought to determine whether racial disparities exist among those children suspected of being victims of child abuse.

Methods: The Kids’ Inpatient Database (KID) database (2006, 2009, 2012, 2016, and 2019) was queried for children admitted with injury. Demographics, injury severity, and hospitalization characteristics of patients with accidental trauma and those with suspected or confirmed child abuse (SCA) were compared by race. Analyses included descriptive statistics, as well as univariate and multivariate regression.

Results: We identified 668,600 children < 18 years old admitted with injury, including 14,522 patients with injuries attributable to abuse. The racial distribution of accidental trauma patients (White 55%, Black 16.1%, Hispanic 20.1%) was similar to the 2010 US census general population (White 56%, Black 13%, 16%). However, among the SCA population, we found White patients were underrepresented (47.9%) and Black patients (24.2%) were overrepresented (OR 1.73, p< 0.001), while Hispanics were slightly overrepresented (19.7%, OR 1.12, p< 0.001). After controlling for socioeconomic factors and hospital type, Black race remained an independent risk factor for child abuse suspicion (OR 1.09, P< 0.004) and Hispanic ethnicity was protective (OR 0.71, P< 0.001) (Table 1). Black SCA patients had similar median age, injury severity score (ISS), and mortality rates as their White counterparts. In multivariate analyses, Black SCA patients had significantly longer hospital stays than White SCA patients. When compared with White SCA patients, Black SCA patients with mild to moderate injuries (ISS 0-15) had a 26% longer length of stay (p < 0.001) and a 39% longer length of stay (p < 0.001) for serious injury (ISS 16-24).

Conclusion: Black children were suspected victims of child abuse at higher rates than other populations. This increased risk of child abuse suspicion persisted after controlling for sociodemographic and hospital characteristics. Although Black children had comparable injury severity and mortality rates as other racial groups, Black children had significantly longer hospital stays. More research is necessary to understand the origins of these disparities and eventually reduce these health disparities in child abuse identification.