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Original Investigation |

The Prevalence of Confirmed Maltreatment Among US Children, 2004 to 2011

Christopher Wildeman, PhD1; Natalia Emanuel, BA2; John M. Leventhal, MD3; Emily Putnam-Hornstein, PhD, MSSW4,5; Jane Waldfogel, PhD, MED6; Hedwig Lee, PhD7
[+] Author Affiliations
1Department of Sociology, Yale University, New Haven, Connecticut
2Department of Economics, Yale University, New Haven, Connecticut
3Department of Pediatrics, Yale University, New Haven, Connecticut
4School of Social Work, University of Southern California, Los Angeles
5Center for Social Services Research, University of California, Berkeley
6School of Social Work, Columbia University, New York, New York
7Department of Sociology, University of Washington, Seattle
JAMA Pediatr. 2014;168(8):706-713. doi:10.1001/jamapediatrics.2014.410.
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Importance  Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals.

Objective  To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age.

Design, Setting, and Participants  The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5 689 900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age.

Main Outcomes and Measures  The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year.

Results  At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010.

Conclusions and Relevance  Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.

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Figure 1.
Proportion of Children Having Ever Experienced Confirmed Maltreatment in 2011

Lifetime prevalence of confirmed maltreatment by race/ethnicity and sex. A, Cumulative prevalence. B, Prevalence among boys. C, Prevalence among girls. All racial/ethnic and sex differences were statistically significant at P < .001.

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Figure 2.
Age-Specific Risk for First Confirmed Maltreatment in 2011

Age-specific risk by race/ethnicity and sex. A, Age-specific risk. B, Risk for boys. C, Risk for girls. Risk was especially high during the first few years of life and declined to a fairly steady rate thereafter, a pattern consistent among racial/ethnic groups.

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Figure 3.
Cumulative Risk of Confirmed Maltreatment by 18 Years of Age During the Study Period

Cumulative risk differed significantly across the study period (P < .001). Prevalence was high even in the lowest years, with similar patterns among racial/ethnic groups.

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