Underascertainment of Child Abuse Mortality in the United States

• NCJ Number: 178701
• Journal: JAMA Volume: 282 Issue: 5 Dated: August 4, 1999 Pages: 463-467
• Author(s): Marcia E. Herman-Giddens; Gail Brown; Sarah Verbiest; Pamela J. Carlson; Elizabeth G. Hooten; Eleanor Howell; John D. Butts
• Date Published: 1999
• Length: 5 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

This study determined the true incidence of fatal child abuse, identified the proportion of child abuse deaths missed by the vital records system, and provided estimates of the extent of abuse homicide in young children.

Abstract

This was a retrospective descriptive study of child-abuse homicides that occurred over a 10-year period in North Carolina from 1985 through 1994. The Medical Examiner Information System was searched for all cases of children younger than 11 years classified with International Classification of Diseases, Ninth Revision codes E960 to E969 as the underlying cause of death and homicide as the manner of death. A total of 273 cases were identified in the search, and 259 cases were reviewed after exclusion of fetal deaths and deaths of children who were not residents of North Carolina. The main outcome measure was child abuse homicide. Of the 259 homicides, 220 (84.9 percent) were due to child abuse, 22 (8.5 percent) were not related to abuse, and the status of 17 (6.6 percent) could not be determined. The rate of child abuse homicide increased from 1.5 per 100,000 person- years in 1985 to 2.8 in 1994. In all 259 cases of child homicides, the state vital records system underrecorded the coding of those due to battering or abuse by 58.7 percent. Black children were killed at three times the rate of white children (4.3 per 100,000 vs. 1.3 per 100,000). Males accounted for 65.5 percent (133/203) of the known probable assailants. Biological parents accounted for 63 percent of the perpetrators of fatal child abuse. From 1985 through 1996, 9,467 homicides among U.S. children younger than 11 years were estimated to be due to abuse rather than the 2,973 reported. The International Classification of Diseases, Ninth Revision codes E960 to E969 underascertained abuse homicides by an estimated 61.6 percent. The study found that significant underascertainment of child abuse homicides in vital records systems persists despite greater societal attention to abuse fatalities. Improved recording of such incidences should be a priority, so that prevention strategies can be appropriately targeted and outcomes monitored, especially in the context of the increasing rates. 5 tables, 1 figure, and 22 references