Socioeconomic Disparities in Infant Mortality After Nonaccidental Trauma: a Multicenter Study

Background: While disparities in abuse-related mortality between minority and white infants have been reported, the influence of socioeconomic status on outcome has not been evaluated. The goal of this study was to determine the impact of socioeconomic status and race on outcomes for abused infants using multiinstitutional data.

Methods: Data on infants (<12 months old) with abusive injuries over a 5-year period were obtained from nine U.S. pediatric trauma centers. Demographics, insurance status, Injury Severity Scores, Glasgow Coma Scale scores, median household income and outcomes were recorded. Logistic regression was used to evaluate the impact of race, income and insurance status on mortality.

Results: There were 867 patients identified with a mortality of 8.8%. Patients without private insurance had a 3.8 times greater odds (give 95% confidence interval) of dying. Those in the lower three quartiles of income also had a higher odds of death even after controlling for race, injury severity, and Glasgow Coma Scale. Although African American infants had a higher overall mortality than whites (11.2% vs. 7.8%, p = 0.14), race was not an independent predictor of mortality (p = 0.98).

Conclusions: There are significant differences in mortality among abused infants associated with insurance status and income even after controlling for injury severity. These associations show a need to better understand and address socioeconomic variations in outcome.