Urban-Rural Residence and Child Physical Abuse Hospitalizations: A National Incidence Study

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Publication Date



DOI: 10.1016/j.jpeds.2018.09.071


© 2018 Elsevier Inc.

Objective: To determine if child physical abuse hospitalization rates vary across urban-rural regions overall and after accounting for race/ethnicity and poverty demographics.

Study design: This was a retrospective cross-sectional study of black, Hispanic, and non-Hispanic white children metro, fringe/small metro, and rural. Incidence rates were calculated using child physical abuse hospitalization counts from the 2012 Kids’ Inpatient Database and population statistics from the 2012 American Community Survey. Counties’ race/ethnicity demographics and percent of children living in poverty were used to adjust rates.

Results: We identified 3082 child physical abuse hospitalizations occurring among 18.2 million children. Neither crude nor adjusted overall rates of child physical abuse hospitalizations varied significantly across the urban-rural spectrum. When stratified by race/ethnicity, crude child physical abuse hospitalization rates decreased among black children 29.1% (P =.004) and increased among white children 25.6% (P =.001) from central metro to rural counties. After adjusting for poverty, only rates among black children continued to vary significantly, decreasing 34.8% (P =.001) from central metro to rural counties. Rates were disproportionately higher among black children compared with white children and their disproportionality increased with population density, even after poverty adjustment. Rates among Hispanic children were disproportionately lower compared with white children in nearly all urban-rural categories.

Conclusions: Our results suggest that urban black children have unique exposures, outside of poverty, increasing their risk for child physical abuse hospitalization. Identifying and addressing these unique urban exposures may aid in reducing black-white disproportionalities in child physical abuse.

Journal Title

Journal of Pediatrics



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disparity; disproportionality; epidemiologic paradox; ethnicity; Hispanic Paradox; maltreatment; poverty; race

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