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Association between socioeconomic status and risk of hospitalization due to child maltreatment in the USA
  1. Sehyr Imran1,
  2. Chad Cross2,3,
  3. Samrat U Das4
  1. 1 Department of Pediatrics, Children’s Mercy, Kansas City, Missouri, USA
  2. 2 Department of Radiation Oncology, UNLV School of Medicine, Las Vegas, Nevada, USA
  3. 3 Department of Environmental and Occupational Health, UNLV School of Community Health Sciences, Las Vegas, Nevada, USA
  4. 4 Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
  1. Correspondence to Dr Samrat U Das, Department of Pediatrics, Duke University School of Medicine, Durham NC 27710, USA; samrat.das{at}


Child maltreatment remains a significant problem in the USA. There is a dearth of literature examining the association of socioeconomic status (SES) and incidence of child maltreatment among hospitalized children across the entire USA. Our aim was to study the association between SES and incidence and mortality from child maltreatment among hospitalized children in the USA. We used 2013–2014 data from the Nationwide Inpatient Sample, a discharge database representative of all hospitals in the USA. International Classification of Diseases-9 codes for general child maltreatment were used to identify patients discharged with a primary diagnosis of child maltreatment. Trends in the incidence and outcomes of child maltreatment were compared with SES based on quartiles (Qx) of median household income. In 2013–2014, there were a total of about 2.3 million pediatric discharges. Out of these, a total of 8985 had a primary diagnosis of child maltreatment. Approximately 40 per cent of the cases were from families with the lowest SES (Q1). In-hospital mortality was 2.4 per cent in Q1 (lowest SES) compared with 0.4 per cent in Q4 (highest SES). We conclude that children from lower SES households have a higher incidence of child maltreatment and have worse outcomes, including significantly higher in-hospital mortality among hospitalized children. This trend was generally consistent across all age groups and ethnicities. To our knowledge, this is the first report studying the association between SES and children with child maltreatment among hospitalized children across the entire USA.

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  • Contributors SI was the lead author on this research. CC provided analytical expertise and interpretation. SUD was the senior and corresponding author and helped supervise this research. All authors discussed the results and contributed to the final manuscript.

  • Funding This study was supported by a research grant provided by the University of Nevada, Reno School of Medicine Resident Research Pathway Program.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Nevada Reno-A category #4 exemption was obtained from Institutional Review Board of University of Nevada, Reno, to conduct this research study [UNR IRB: 1048508-1].

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at The work has been presented in abstract form at the Western Medical Research conference, January 25–27, 2018, Carmel, California, and as platform presentation at the Pediatric Academic Society Meeting, May 5–8, 2018, Toronto, Canada.