177 - Racial Disparity and Disproportionality Among Emergency Department Visits for Child Maltreatment: Evidence from 2019-2020 Nationwide Emergency Department Sample (NEDS) Database.
Medical Student University of Connecticut School of Medicine Farmington, Connecticut, United States
Background: Child maltreatment is a major public health problem in the United States. In 2021, Child Protective Services (CPS) data shows an estimated 600,000 children were substantiated victims of maltreatment representing a rate of 8.1 victims per 1,000 child population. An analysis using national data from CPS has demonstrated that Black/African American children experience the burden of substantiated maltreatment at a rate that is 47% higher than the national average. It is unclear, however, whether a similar disparity exists in national emergency department (ED) data, as the Nationwide Emergency Department Sample (NEDS) only began collecting patient race/ethnicity in 2019. This historical omission has prohibited a thorough examination of race/ethnic trends among pediatric ED visits for maltreatment. Objective: To establish racial disparity and disproportionality among ED visits involving child maltreatment captured in NEDS. Design/Methods: Our analysis included patients < 18 years-old captured in NEDS (2019-2020) with an International Classification of Disease, 10th Revision, Clinical Modification code (ICD-10-CM) for child maltreatment (confirmed and suspected). Demographic characteristics were evaluated by maltreatment type, age, gender, and race/ethnicity. NEDS sampling weights were applied to produce national estimates. Racial disparity and disproportionality were calculated using the Disparity Index (DI) and the Disproportionality Representation Index (DRI), respectively. Results: A total of 29,667 ED visits (130,981 weighted) involving child maltreatment concerns were identified. The DRI revealed that non-Hispanic Black (NHB) children visited EDs for maltreatment at a rate that was 1.8 times the expected rate based on their proportion in the general population. The DI showed that maltreatment-related ED visits among NHB children occurred at a rate that was 2.1 times that of their non-Hispanic white (NHW) counterparts. Further analysis by race/ethnicity and gender showed that NHB children and NHW females had maltreatment concerns identified in the ED at quadruple the rate of NHW males.
Conclusion(s): This research exposes racial and gender differences in child maltreatment documentation at the national level. Future research should investigate the reasons for these differences, including associated biases which may influence maltreatment evaluation and surveillance efforts.
