Using time-to-event analysis to identify preconception and prenatal predictors of child protective services contact
Using time-to-event analysis to identify preconception and prenatal predictors of child protective services contact
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DOI：
10.1016/j.chiabu.2018.05.025
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发表时间：
2018-08-01
影响因子：
4.8
通讯作者：
Shanahan, Meghan E.
中科院分区：
文献类型：
--
作者：
Austin, Anna E.;Parrish, Jared W.;Shanahan, Meghan E.
我们研究了阿拉斯加儿童首次接触儿童保护服务（CPS）的孕前和产前预测因素。数据来自阿拉斯加纵向虐待儿童和新生儿联系（ALCANLink）项目，这是一个人口代表性数据源，将2009-2011年阿拉斯加妊娠风险评估监测系统（PRAMS）数据与2015年的行政数据源联系起来。我们使用Kaplan Meier方法检查CPS接触的发生率，并使用考克斯比例风险回归分析CPS接触的预测因子。使用阿拉斯加永久基金股息和儿童死亡审查的数据，我们审查了在研究期间移民到州外或死亡的儿童。重要的预测因素包括低社会经济地位（HR = 2.23，95% CI 1.68，2.96），母亲在妊娠期间吸烟（HR = 1.87，95% CI 1.55，2.24），未婚母亲婚姻状况（HR = 1.62，95% CI 1.31，1.99），城市居民（HR = 1.59，95% CI 1.32，1.92），母亲受教育程度较低（HR = 1.54，95% CI 1.24，1.92），分娩前12个月内母亲遭受亲密伴侣暴力的经历（HR = 1.32，95% CI 1.01，1.74），阿拉斯加土著/美洲印第安人（FIR = 1.40，95% CI 1.15，1.71），存活儿童数量更多（HR = 1.20，95%CI 1.13，1.29），产前12个月内的压力性生活次数更多（HR = 1.16，95% CI 1.11，1.21），以及分娩时母亲年龄较小（HR = 0.95，95% CI 0.93，0.97）。使用多个链接的数据源和时间到事件的分析方法增加了越来越多的文献CPS接触的预测。结果表明，在产前评估和解决临床，社会和环境指标可能有助于预防工作，减轻家庭需要参与CPS。
We examined preconception and prenatal predictors of time to first child protective services (CPS) contact among Alaska children. Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a population-representative data source linking 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with administrative data sources through 2015. We examined the incidence CPS contact using the Kaplan Meier method and predictors of CPS contact using Cox proportional hazards regression. Using data from the Alaska Permanent Fund Dividend and Child Death Review, we censored children who emigrated out-of-state or died during the study period. Significant predictors included low socioeconomic status (HR = 2.23, 95% CI 1.68, 2.96), maternal smoking during pregnancy (HR = 1.87, 95% CI 1.55, 2.24), unmarried maternal marital status (HR = 1.62, 95% CI 1.31, 1.99), urban residence (HR = 1.59, 95% CI 1.32, 1.92), lower maternal education (HR = 1.54, 95% CI 1.24, 1.92), maternal experience of intimate partner violence in the 12 months before childbirth(HR = 1.32, 95% CI 1.01, 1.74), Alaska Native/American Indian race (FIR = 1.40, 95% CI 1.15, 1.71), a greater number of living children (HR = 1.20, 95% CI 1.13, 1.29), a greater number of stressful life eventsin the 12 months before childbirth (HR = 1.16, 95% CI 1.11, 1.21), and younger maternal age at childbirth (HR = 0.95, 95% CI 0.93, 0.97). Use of multiple linked data sources and time-to-event analysis methods adds to the growing literature regarding predictors of CPS contact. Results suggest that assessing for and addressing clinical, social, and environmental indicators during the prenatal period may aid prevention efforts in mitigating family need for involvement with CPS.