Racial Disparities In The Evaluation Of Suspected Child Abuse
Modupeola Diyaolu1, Chaonan Ye1, Ryan Han1, Hannah Wild2, Lakshika Tennakoon1, Rachel Landisch1, *David A Spain1, *Stephanie D Chao1
1Stanford Medical Center, Stanford, CA;2University of Washingotn, Seattle, WA
Background: Child abuse is a significant cause of injury and death among children, but accurate identification is often challenging. This study aims to assess whether racial disparities exist in the identification of suspected child abuse.Methods: The 2010-2014 and 2016-2017 NTDB was queried for trauma patients ages 1-17. Using ICD-9CM and ICD-10CM codes, children with injuries consistent with child abuse were identified and analyzed by race using chi-square and ANOVA. Statistical significance was determined with p-value<0.05.Results: Between 2010-2014 and 2016-2017, 798,353 patients were included in NTDB. Suspected child abuse victims (SCAN) accounted for 7903 (1%) patients. Of these, 51.3% were White, 32.8% Black, 1.1% Asian, 0.3% Native Hawaiian/Other Pacific Islander, 2.1% American Indian, and 12.4% other. Black patients were disproportionately overrepresented, composing 12% of the US population, but 32.8% of SCAN patients (p<0.001). Although White SCAN patients were more severely injured (ISS 16-24: 20.44% vs 16%, p<0.01) and had higher in-hospital mortality (9% vs. 6%, p=0.01), Black SCAN patients were hospitalized longer (7.2±31.4 vs. 6.2±9.9 days, p<0.01) despite controlling for ISS (1-15: 5.7±35.7 vs. 4.2±6.2 days, p<0.01). In multivariate regression, Black children continued to have longer lengths of stay despite controlling for ISS and insurance type. Conclusions: Utilizing a nationally representative dataset, Black children were disproportionately identified as potential victims of abuse. When compared with abused White children, Black children were subject to longer hospital stays, despite milder injuries. Further studies are needed to better understand the etiology of the observed trends and whether they reflect potential underlying unconscious or conscious biases of mandated reporters.
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