October 13, 2008

Lack of Insurance Raises Abused Babies' Death Risk

MONDAY, Oct. 13 (HealthDay News) - Infant victims of abuse whose families don't have private health insurance are almost four times more likely to die, compared with abused babies who are privately insured, a new study finds.

In addition, abused infants from poor families are 3.5 to almost seven times more likely to die compared with babies from affluent families, according to the report, which was to be presented over the weekend at the annual meeting of the American Academy of Pediatrics, in Boston.

"Children less than a year old who suffer physical abuse have a high mortality," noted lead researcher Dr. Richard Falcone, associate director of trauma services at Cincinnati Children's Hospital Medical Center. "But the really disturbing problem was that those children who did not have private insurance, or children from low-income families, had even worse outcomes," he said.

Children admitted to hospitals or trauma centers for such injuries have a mortality rate of about 8 percent, "which is much higher than mortality rates from other injuries, which are closer to about 1 percent," Falcone said.

"This is a disturbing and unacceptable difference in outcomes," Falcone added. "We need to ensure that all children are receiving equal access and equal care, so they can have the best potential outcomes."

For the study, Falcone's team collected data on 867 infants under 12 months of age, who were admitted to hospitals for injuries caused by abuse.

The researchers found that, overall, 8.8 percent of these children died. However, infants without private health insurance were 3.8 times more likely to die compared with infants who were privately insured.

"This was true, despite our efforts to control for how severely injured those children were," Falcone noted. The association remained even after race was taken into account, the researchers found.

The reasons for this association are unclear, Falcone said. "It's a complicated problem. Maybe these babies are less healthy, less able to respond to these unfortunate injuries. That may be related to lack of prenatal care, difficulty getting access to early childhood care because of lack of insurance or economic strains," he said.

It could also be due to differences in the quality of care delivered by doctors and hospitals, Falcone noted. "It is our responsibility to prove to ourselves and to the community that it's not the quality of care that they received after the injury that's different," he said. "We need to find out what all the problems are and how to address them.

Falcone noted that while many of the children without private health insurance were uninsured, some were covered by state or federal programs, such as SCHIP or Medicaid. However, whether or not they had state sponsored insurance before being admitted to the hospital is not known, he said.

Dr. Carole Jenny, chair of the Committee on Child Abuse and Neglect at the American Academy of Pediatrics, and director of the Child Protection Program at Hasbro Children's Hospital in Providence, R.I., believes the study raises a key issue.

"This is an extremely important study," Jenny said. "The diagnosis of child abuse should be blinded to race, family composition or socioeconomic status," she said.

In a previous study, Jenny found that in abused children, serious head injuries were more likely to be missed by physicians if the child was white and from an intact family.

"This was essentially a reverse bias -- making the abuse of white children more likely to be overlooked, thus putting them at risk for further abuse," Jenny said.

More information

For more on child abuse, visit the U.S. National Library of Medicine.

SOURCES: Richard Falcone, M.D., associate director, Trauma Services, Cincinnati Children's Hospital Medical Center, Ohio; Carole Jenny, M.D., chair, Committee on Child Abuse and Neglect, American Academy of Pediatrics, and director, Child Protection Program, Hasbro Children's Hospital, Providence, R.I.; Oct. 11, 2008, presentation, annual meeting, American Academy of Pediatrics, Boston
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