Child maltreatment risk as a function of poverty and race/ethnicity in the USA
Child maltreatment risk as a function of poverty and race/ethnicity in the USA
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DOI：
10.1093/ije/dyx280
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发表时间：
2018-06-01
影响因子：
7.7
通讯作者：
Drake, Brett
中科院分区：
文献类型：
--
作者：
Kim, Hyunil;Drake, Brett
背景：虐待儿童在美国和国际上是一个紧迫的社会问题。越来越多的人呼吁使用公共卫生方法来处理虐待儿童问题，但有效地采用这种方法需要有良好的流行病学数据基础。这项研究首次利用国家数据，在同时考虑环境贫困和种族/民族的同时，估计了总体和特定类型的官方虐待风险。方法：将国家官方虐待数据(2009-2013年)与人口普查数据联系起来。我们使用加性混合模型来估计官方虐待的种族/民族特定比率(总和亚类)作为县级儿童贫困率的函数。加性模型与多水平设计相结合，在处理曲线和嵌套数据结构的同时提供了经验上合理的估计。结果：随着县儿童贫困率的增加，所有种族/民族群体的总和特定类型的官方虐待发生率都增加了。在类似的贫困水平下，白人的虐待比率倾向于高于黑人，而西班牙裔的虐待比率则较低，特别是在数据最充分的地方。例如，在25%的贫困水平下，白人的总虐待报告率为6.91%[95%可信区间：6.43%-7.40%]，黑人为6.30%(5.50%-7.11%)，西班牙裔为3.32%(2.88%-3.76%)。结论：在所有种族/民族中，官方虐待儿童与环境贫困之间存在很强的正相关关系。我们的数据表明，黑人/白人在官方虐待中的不成比例很大程度上是由贫困中的黑人/白人差异造成的。我们的发现也支持了官方虐待中存在的“拉美裔悖论”，即与经济状况相似的白人和黑人相比，拉美裔的风险更低。
Background: Child maltreatment is a pressing social problem in the USA and internationally. There are increasing calls for the use of a public health approach to child maltreatment, but the effective adoption of such an approach requires a sound foundation of epidemiological data. This study estimates for the first time, using national data, total and type-specific official maltreatment risks while simultaneously considering environmental poverty and race/ethnicity.Methods: National official maltreatment data (2009-13) were linked to census data. We used additive mixed models to estimate race/ethnicity-specific rates of official maltreatment (total and subtypes) as a function of county-level child poverty rates. The additive model coupled with the multilevel design provided empirically sound estimates while handling both curvilinearity and the nested data structure.Results: With increasing county child poverty rates, total and type-specific official maltreatment rates increased in all race/ethnicity groups. At similar poverty levels, White maltreatment rates trended higher than Blacks and Hispanics showed lower rates, especially where the data were most sufficient. For example, at the 25% poverty level, total maltreatment report rates were 6.91% [95% confidence interval (CI): 6.43%-7.40%] for Whites, 6.30% (5.50%-7.11%) for Blacks and 3.32% (2.88%-3.76%) for Hispanics.Conclusions: We find strong positive associations between official child maltreatment and environmental poverty in all race/ethnicity groups. Our data suggest that Black/White disproportionality in official maltreatment is largely driven by Black/White differences in poverty. Our findings also support the presence of a 'Hispanic paradox' in official maltreatment, where Hispanics have lower risks compared with similarly economically situated Whites and Blacks.