Is Underimmunization Associated With Child Maltreatment?
Received 13 August 2007; accepted 14 January 2008. published online 14 April 2008.
Objective
To assess the relationship between underimmunization and child maltreatment among children referred to a child advocacy center for a child maltreatment evaluation.
Methods
We conducted a secondary data analysis of 399 children aged 3 to 48 months who were referred to a child advocacy center at an academic medical center. The primary independent variable was age-appropriate immunization status. The dependent variable was maltreatment (confirmed, suspected, or ruled out). Multivariate models were used to control for insurance, race/ethnicity, and maternal education.
Results
At 3 and 7 months of age, underimmunized children were significantly more likely to have confirmed maltreatment than children whose immunizations were up to date (at 3 months, 32.0% vs 17.6%, P < .05; at 7 months, 23.7% vs 8.6%, P < .01). At 19 months, rates were not significantly different (16.1% vs 24.1%, P = .33). In multivariate analyses, children underimmunized at 3 or 7 months of age were 4 times more likely to have confirmed maltreatment compared with children whose immunizations were up to date (at 3 months, adjusted odds ratio [AOR], 3.97, 95% confidence interval [95% CI], 1.67–9.49; at 7 months, AOR, 4.79, 95% CI, 1.47–15.66). This relationship was statistically significant for children evaluated for physical abuse (AOR, 4.34, 95% CI, 1.18–16.02), but not for sexual abuse.
Conclusions
Underimmunization at 3 and 7 months of age was associated with confirmed maltreatment, specifically physical abuse, in children evaluated for child maltreatment. The association between underimmunization and child abuse in the general population deserves further study.
From the Division of General Pediatrics, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY (Dr Stockwell, Dr Brown, Dr Chen, and Dr Irigoyen); the Department of Biostatistics (Dr Vaughan) and the Heilbrunn Department of Population and Family Health (Dr Irigoyen and Dr Stockwell), Mailman School of Public Health, Columbia University, New York, NY
Address correspondence to Melissa S. Stockwell, MD, MPH, Division of General Pediatrics, Columbia University, 622 W 168th St, VC 402, New York, New York 10032.
Presented in part as a poster at the Pediatric Academic Societies' Annual Meeting, San Francisco, Calif, April 2006; and at the Eastern Society for Pediatric Research Annual Meeting, Greenwich, Conn, March 2006.
ABSTRACT