Perinatal & Pediatric
Comparing temporal trends and racial differences in child maltreatment identified in child protective services reports and hospital administrative data in California, 2005–2019 Sophia Horiuchi* Sophia Horiuchi Horiuchi Horiuchi Horiuchi Horiuchi Horiuchi sophiehoriuchi@berkeley.edu
Child maltreatment is often measured using Child Protective Services (CPS) reports, despite the potential for racial biases in reporting and changes in CPS policies and practices to spuriously influence demographic and temporal patterns. Hospitalizations and emergency department visits for injuries suggestive of maltreatment offer a complementary data source on serious health outcomes of maltreatment. We compared rates of child physical abuse and neglect identified in hospital data with CPS reports among children aged <5 years in California from 2005 to 2019.
Hospital visits suggestive of physical abuse and neglect were identified using validated diagnosis codes in statewide hospital data from the California Department of Health Care Access and Information. CPS reports of physical abuse and neglect were obtained from the National Child Abuse and Neglect Data System. Annual statewide rates of physical abuse and neglect, separately and combined, were calculated using population estimates from the Surveillance, Epidemiology, and End Results Program. Patterns by race/ethnicity and time were compared across the two data sources.
Across both data sources, combined physical abuse and neglect rates (per 10,000 children) increased and then declined over time, with a later peak in CPS than hospital data. Hospital injury rates rose from 48.5 in 2005 to a peak of 58.8 in 2009, while CPS reporting rates increased from 368.7 in 2005 to a peak of 431.3 in 2014. Non-Hispanic Black children had higher rates than Non-Hispanic White children in both data sources, but with a much larger relative difference in CPS data.
Temporal and demographic maltreatment patterns differ when measured using CPS and hospital data, likely reflecting differences in the severity of cases and in how cases are identified. In addition to CPS outcomes, studies evaluating policies to prevent child maltreatment should examine effects on maltreatment-related injuries captured in hospital data.
