Importance Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals.
Objective To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age.
Design, Setting, and Participants The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5 689 900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age.
Main Outcomes and Measures The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year.
Results At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010.
Conclusions and Relevance Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.
Child maltreatment—encompassing neglect and physical, sexual, and emotional abuse of children—is associated with myriad negative physical, mental, and social outcomes. Childhood maltreatment is associated with significantly higher rates of mortality,1- 3 obesity,1,4- 7 and human immunodeficiency virus infection.1,8 Children who experience maltreatment also have significantly more mental health problems1,9- 14 and are as much as 5 times more likely to attempt suicide.1,15 Maltreated children are also more likely to engage in criminal behavior than other children1,16,17 and are more than 50% more likely to have a juvenile record than other children.17 Child maltreatment also has substantial social costs. Estimates suggest that child maltreatment costs the United States $124 billion annually, with per-person lifetime costs higher than or comparable to those of diseases such as a stroke or type 2 diabetes mellitus.18 Childhood maltreatment has thus been referred to as “a human rights violation and a global public health problem [that] incurs huge costs for both individuals and society.”19(p332)
However, a large disparity exists between estimates of the prevalence of maltreatment based on retrospective self-reports and those derived from officially documented maltreatment by Child Protective Services (CPS). Retrospective self-reports indicate that child maltreatment is widespread annually and cumulatively during the course of childhood, with 2 studies20,21 using recent data to report that more than 40% of children will be maltreated during childhood. In contrast, official CPS data indicate that far fewer children experience maltreatment. For example, in 2011, only 0.9% of children were confirmed as victims of maltreatment.22 We do not know the extent to which the difference between these 2 estimates can be attributed to the fact that estimates of confirmed maltreatment only capture the number of children maltreated annually and thus do not reflect the population of children maltreated during the entirety of childhood.
Although other fields have used synthetic cohort life tables to document the cumulative risk of experiencing an event, no such attempts have been made using official child maltreatment data.23 Therefore, the purpose of this study was to use synthetic cohort life tables to determine the percentage of US children confirmed as maltreated according to CPS from birth to 18 years of age. We also estimated differences in maltreatment by race/ethnicity, sex, and year from 2004 through 2011.