Population-based, Birth Cohort Studies of Child Deaths Before Age 5

Summary

This line of population-based child fatality research is based on a unique dataset constructed by linking records across three sources of California data: 1) vital birth records, 2) administrative child protective service (CPS) records, and 3) vital death records. These data allowed researchers to follow 4.3 million children born in California between 1999 and 2006 and includes maltreatment allegations for over 500,000 children reported to CPS, as well as death information for roughly 25,000 children who died before age 5. To date, these data have been used to study unintentional and intentional injury fatalities, as well as Sudden Infant Death Syndrome (SIDS) and other Sudden and Unexpected Infant Deaths (SUIDs).

Overview of Findings

These data provide the most rigorous longitudinal analysis of mortality outcomes following a report to CPS to date, with several key findings emerging.

CPS Report as a Signal of Risk: These data indicate that a child’s report to CPS for maltreatment is not random, nor is it simply a function of poverty. After adjusting for other risk factors, children reported for maltreatment sustained inflicted fatal injuries at 5.9 times the rate of children who had not been reported. A prior allegation of maltreatment was the single strongest predictor of intentional injury death. Although the National Incidence Studies and other sources of surveillance data suggest that the CPS system misses a large share of maltreated children, the heightened rates of intentional injury deaths leave little doubt that those children who are known to CPS do, in fact, face threats that run far deeper than poverty or sociodemographic factors alone would indicate. In public health research, death is frequently employed as a marker of population-level differences in health and well-being. These data demonstrate that a report of maltreatment to CPS is more than just a marker of poverty—it is an independent signal of child risk.

Unintentional and Intentional Injuries: A second finding to emerge is that a narrow focus on intentional or maltreatment-related deaths fails to consider that children reported for maltreatment also die from unintentional injuries at twice the rate of unreported peers. Linked data indicate that children reported to CPS have a significantly heightened risk of not only intentional/maltreatment-related injury death, but also unintentional injury death. After adjusting for other risk factors, children reported to CPS died from unintentional injuries at twice the rate of other children who had not been reported. Likewise, infants reported to CPS died of SIDS at more than 3 times the rate of infants who had not been reported. These findings suggest that child protection campaigns should focus on the prevention and surveillance of fatalities broader than just those designated as intentional.

Products

Coverage and Commentary

"New Study Points to Danger of Child Neglect"
The Chronicle of Social Change, September 2013

"A Public Health Approach to Preventing Maltreatment Related Child Deaths"
The Sounding Board, August 2013

"An Investigative Review of Sudden Infant Death"
The Boston Globe, July 2014

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