Characteristics of Neighborhoods Where Emergency Medical Services Encounter Children at Risk for Maltreatment

Abstract

Objective: The objective of this study was to determine if neighborhood rates of pediatric Emergency Medical Services (EMS) encounters correlate with rates of child maltreatment reporting and if there are neighborhood-level risk factors for EMS encountering children with maltreatment reports. Methods: We conducted a retrospective cohort study using the electronic medical records of children ages <18 years who had Columbus Division of Fire EMS encounters between 2011 and 2015. We used Nationwide Children’s Hospital electronic medical records to identify child maltreatment reports. The EMS scene addresses and home addresses associated with maltreatment reports were geocoded independently and rates for each Census tract were calculated. The maltreatment reports were matched to the EMS encounters using name, gender, and date of birth. Rates of EMS encounters with children that had a maltreatment report were calculated for each Census tract. Census tract demographic information was obtained from the American Community Survey. Bayesian conditional autoregressive Poisson models were used to calculate rate ratios for census tract variables to determine their relationship to EMS encountering children with maltreatment reports. Results: A total of 44,002 EMS encounters and 4,298 maltreatment reports were included in the study. The Spearman correlation coefficient relating rates of EMS encounters to rates of maltreatment reports within census tracts was 0.72 (95% confidence interval, 0.65–0.77). Within the study period, a total of 1,134 EMS encounters were linked to 578 children with maltreatment reports. Poverty was the only independent risk factor for EMS encountering children with maltreatment reports. The multivariate analysis also identified protective factors, which included neighborhoods with higher proportions of residents who had bachelor’s degrees, spoke a language other than English, and had the same residence the previous year. Conclusion: This study showed that in Franklin County, Ohio, neighborhoods with high EMS utilization had a strong positive correlation with areas that had high rates of child maltreatment reports. We also identified four neighborhood characteristics that were independently associated with EMS encountering children at risk for maltreatment (risk factor: poverty; protective factors: residents with college educations, non-English speaking households, and residents maintaining the same residence as the previous year).

Key words:

• emergency medical services
• child abuse
• child maltreatment
• risk factors
• protective factors
• poverty