214 - Child Maltreatment as a Risk Factor for Violent Death

Poster Number: 214
Publication Number: 214.401

Nicole M. Barrett, Nationwide Children's Hospital, Columbus, OH, United States; Farah Brink, Nationwide Children's Hospital, Columbus, OH, United States; Sandhya Kistamgari, Nationwide Children's Hospital, Columbus, OH, United States; Gary A. Smith, Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH, United States; Nichole Michaels, Nationwide Children's Hospital, Columbus, OH, United States

Background: Adverse childhood experiences including child maltreatment contribute to poor long-term health and premature mortality. Child maltreatment victims are at risk for death by physical abuse; however, less is known about their risk for other violent deaths over time. Identifying child maltreatment as a risk factor for future violent deaths would have prevention and public policy implications.

Objective: 1. To determine the proportion of victims of violent deaths with an identified history of child maltreatment. We hypothesize that greater than 1.5% of victims of violent deaths will have a history of child maltreatment.
2. To compare fatality distributions and case characteristics of decedents with a known history of child maltreatment to those without. We hypothesize that decedents with a history of child maltreatment will be more likely to die by suicide and die at an earlier age than non-maltreated decedents.

Design/Methods: This retrospective study evaluated violent deaths in the United States captured in the National Violent Death Reporting System (NVDRS) from 2014-2018. Key variables and a key phrase search in the medical examiner/coroner and law enforcement reports were used to determine a history of child maltreatment. Fatality distributions and case characteristics were compared using logistic regression models and adjusted odds ratios.

Results: Of the 198,284 violent deaths during the study period, 2421 (1.22%) had a history of child maltreatment. The manners of death were: 61.4% suicide, 29.0% homicide, 0.6% unintentional firearm, 0.5% legal intervention, 8.6% undetermined. Decedents with a history of maltreatment were more likely to be male, white, non-Hispanic, or have a substance use disorder or mental health problem. All-age decedents with a history of maltreatment were less likely to die from suicide (AOR 0.51, 95% CI 0.41-0.60), but those ≥ 18 years old at time of death were more likely to die from suicide (AOR 2.71, 95% CI 1.93-3.80). Decedents with known mental health problems and a history of maltreatment were more likely to die from suicide (AOR 3.65, 95% CI 2.85-4.68). Decedents with a history of maltreatment were more likely to die from homicide (AOR 2.11, 95% CI 1.81-2.45) and died significantly younger (mean=25 years) than non-maltreated decedents (mean=44 years) (pConclusion(s): A history of child maltreatment is associated with premature mortality and increased risk of death by suicide as an adult. The results of this study suggest the need for targeted prevention strategies among those with a history of child maltreatment.
CV Nicole M. BarrettCV.pdf
Table 2Manners of death of decedents with a history of child maltreatment, NVDRS 2014-2018