340 - Child Physical Abuse Hospitalizations Across Levels of Community Advantage During the COVID-19 Pandemic

Publication Number: 340.4055

Henry T. Puls, Children's Mercy Kansas City, Kansas City, MO, United States; Daniel Lindberg, University of Colorado Anschutz Medical Campus, Denver, CO, United States; Clemens Noelke, Brandeis University, Waltham, MA, United States; Anna E. Austin, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Barbara Chaiyachati, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States; Matthew Hall, Children's Hospital Association, Lenexa, KS, United States

Background: Aggregate rates of child physical abuse (CPA) did not increase during the COVID-19 pandemic as expected. However, community factors are known to influence CPA risk and may have buffered risk differently for some communities during the pandemic.

Objective: To determine the moderating effect community advantage may have had on rates of CPA hospitalizations during the pandemic.

Design/Methods: This was a population-based retrospective study of 12 states during 2019-2021 (AZ, IA, KY, MI, MN, NC, NE, NJ, NY, OR, RI, WI). The Child Opportunity Index 3.0 (COI) measured ZIP code level community advantage. The COI is a composite index of 44 indicators on the education, health & environment, and social & economic characteristics of a community. We measured ZIP code level counts of CPA hospitalizations among children < 5 years (age restriction to optimize accuracy) using AHRQ State Inpatient Databases, which contain all hospitalizations in a state-year for all payers. Pandemic periods were defined a priori based upon documented patterns of healthcare use and public health pandemic responses: pre- (Jan 2019-Feb 2020), early- (Apr 2020-Aug 2020), and mid- (Sept 2020-Dec 2021). Monthly CPA hospitalization rates per 100,000 children with 95% confidence intervals (CI) were calculated for each quintile of COI (very low, low, moderate, high, and very high) and each pandemic period. Chi-square tests compared frequencies and Poisson regression models compared rates between pandemic periods, overall, and stratified by COI quintiles.

Results: Monthly rates of CPA hospitalizations in the pre-pandemic period increased in a non-linear manner from very high COI (0.74 [95% CI 0.61, 0.91]) to very low COI (2.52 [95% CI 2.19, 2.90]), with a consistent pattern across the periods. There were no significant differences in age, race and ethnicity, payer, type of abusive injury, or mortality among the children hospitalized for CPA between the pandemic periods (Table). Overall monthly rates of CPA hospitalizations were not significantly different in the early- (1.75 [95% CI 1.57, 1.95]) or mid-pandemic (1.92 [95% CI 1.80, 2.04]) periods compared to pre-pandemic (1.83 [95% CI 1.71, 1.95]). Compared to COI-stratified pre-pandemic rates, rates of CPA hospitalizations were greater in the early-pandemic period for low COI ZIPs and greater in the mid-pandemic period for moderate COI ZIPs; otherwise, COI quintile-specific rates did not differ between pandemic periods (Figure).

Conclusion(s): Rates of CPA appeared relatively unchanged during the pandemic across different demographics of children and levels of community advantage.

Table
COVID COI Abuse 10.18.24.pdf

Figure
Child physical abuse hospitalization rates stratified by quintile of the Child Opportunity Index (COI) 3.0 across the three periods of the COVID-19 pandemic.
* Rate within the low COI quintile during the early-pandemic period was significantly greater than the rate within the low COI quintile during the pre-pandemic period (p= 0.035).
** Rate within the moderate COI quintile during the mid-pandemic period was significantly greater than the rate within the moderate COI quintile during the pre-pandemic period (p= 0.012).
Otherwise, all rates within individual COI quintiles were not statistically dissimilar to pre-pandemic rates within the same COI quintile.

Table
COVID COI Abuse 10.18.24.pdf

Figure
Child physical abuse hospitalization rates stratified by quintile of the Child Opportunity Index (COI) 3.0 across the three periods of the COVID-19 pandemic.
* Rate within the low COI quintile during the early-pandemic period was significantly greater than the rate within the low COI quintile during the pre-pandemic period (p= 0.035).
** Rate within the moderate COI quintile during the mid-pandemic period was significantly greater than the rate within the moderate COI quintile during the pre-pandemic period (p= 0.012).
Otherwise, all rates within individual COI quintiles were not statistically dissimilar to pre-pandemic rates within the same COI quintile.