Sociodemographic Risk Factors for Abusive Head Trauma in Infants in Pennsylvania

Background. Abusive head trauma (AHT) is a serious injury that can lead to severe disability or death, especially in infants. Little is known about the sociodemographic risk factors for AHT in infants.

Methods. Pennsylvania hospital discharge data from 2000-2011were examined. International Classification of Diseases and external cause-of-injury codes were used to compare cases of abusive (n=754) and non-abusive (n=6475) head trauma according to CDC recommendations in infants ≤12 months old. We examined potential risk factors for AHT using logistic regression models.

Results. Average annual incidence rate for AHT was 43.3 per 100,000 live births. Higher odds of abuse occurred among infants with a high injury severity score (aOR 12.55, 95% CI 10.31-15.27) and in fatal cases (aOR 2.50, 95% CI 1.47-4.27). Minority infants had a reduced odds of abuse compared to non-Hispanic Whites (aOR 0.79, 95% CI 0.65-0.96) and infants with public insurance had an increased odds of abuse compared to those with private insurance (aOR 3.47, 95%CI  2.80-4.31). Stratified analysis revealed that non-Hispanic Whites with public insurance (aOR 3.76, 95% CI 2.94-4.81) and minorities with public insurance (aOR 2.79, 95% CI 2.17-3.60) had an increased odds of AHT compared to non-Hispanic Whites with private insurance. We found no difference in risk between non-Hispanic Whites and minorities with private insurance. There was no association between AHT and gender in our sample.

Conclusions. Our results indicate that the risk of AHT in infants may be strongly associated with insurance status, with non-Hispanic Whites with public insurance at highest risk.