Did a review of death certificate data reveal an underreporting of fatalities due to child abuse?



Did a review of death certificate data reveal an underreporting of fatalities due to child abuse?

Herman-Giddens, M. E., Brown, G., Verbiest, S., Carlson, P. J., Hooten, E. G., Howell, E., & Butts, J. D. (1999). Underascertainment of child abuse mortality in the United States. JAMA, 282(5), 463-467.

What can we learn from this study?

Although the number of states with fatality review teams has increased, the true incidence of child abuse fatalities is unknown. This study compared the coded causes of deaths on death certificates of children ages 10 and younger in North Carolina with data from the state’s Medical Examiner’s office, which has perpetrator information (collected through its own records and from law enforcement agencies). Researchers completed a case-level review of all child homicides, which allowed them to determine the proportion of child abuse deaths missed by the vital records system.

Study details:

  • Population: 259 homicide deaths of children 10 years old or younger who were residents of North Carolina
  • Data source: North Carolina Medical Examiner Information System cause-of-death classifications of homicide and injury purposefully inflicted on other persons (using the International Classification of Diseases, Ninth Revision)
  • Methodology: Retrospective descriptive study
  • Dates: 1985 - 1994

What are the critical findings?

  • Child abuse accounted for 84.9% of all child homicides (N=220 out of 259). The remainder was either not related to abuse (8.5%) or indeterminate (6.6%).
  • The number of homicides caused by child abuse identified by the study (N=220) was 3.2 times higher than the number reported through the state’s vital records system (N=68).
  • Most victims of child homicide were killed by parents (63%) or other caregivers known to them (34%) rather than strangers (3%). Among perpetrators who were biological parents, gender was fairly evenly split (52.3% males, 47.7% females). However, when including deaths at the hands of all caregivers (including relatives, friends, babysitters, stepparents, and boyfriends/girlfriends), nearly two-thirds of perpetrators were male (65.5%).
  • Study authors found that 58.7% of child abuse deaths in North Carolina were not coded as such.
  • Extrapolating to the rest of the United States, study authors estimated that 61.6% of child abuse deaths nationwide were not coded as such.

Why is this important for our work?

The classification of cause of death in vital records systems using the International Classification of Diseases undercounts the number of child fatalities that occur due to child abuse. Although the number of states with child fatality review teams has grown, not all fatalities are reviewed. Further study is needed regarding the risk factors for — and prevalence of — abuse-related fatalities, which can help develop and direct prevention efforts.

This summary synthesizes the findings from a single research study. To learn more about child fatalities, please review Casey’s resources on child abuse and neglect fatalities. For additional information, access the article directly or email KMResources@casey.org.