Structural evaluation of child physical abuse in trauma: Social determinants of health at the population level

Philip Kyung Woo Hong, Juan Pablo Santana, Shawn D. Larson, Amy Berger, Moiz M. Mustafa, Janice A. Taylor, Saleem Islam, Dan Neal, Robin T. Petroze

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Purpose: Child physical abuse (CPA) is closely linked to social factors like insurance status with limited evaluation at a structural population-level. This study evaluates the role of social determinants of health within the built environment on CPA. Methods: A single-institution retrospective review of pediatric trauma patients was conducted between January 2016 and December 2020. Patient address was geocoded to the census-tract level. Socioeconomic metrics, including poverty rate, supermarket access and Social Vulnerability Index (SVI) were estimated from the Food Access Research Atlas. Univariate and multivariable regression analyses were conducted to compare demographics and outcomes. Results: Of 3,540 patients, 317 (9.0%) had concern for physical abuse reported in the registry. CPA patients were younger (7.5 vs 9.6 years, p<0.0001) and more often Black (37.0%, N = 117 vs 23.5%, N = 753; p<0.0001). CPA had higher injury severity scores (ISS) (7.9 vs 5.8, p<0.0001) and longer length of stay (5.3 vs 2.9 days, p<0.0001). CPA had higher Medicaid (73.0%, N = 232 vs 53.8%, N = 1748, p<0.0001) and SVI (0.65 vs 0.59, p<0.0001) with lower median income ($52,100 vs $56,100, p<0.0001) and more low-food access tracts (59.6% vs 53.6%, p = 0.06). Combined low-income and low-food access populations showed widened disparities (40.0% vs 28.9%, p = 0.0002). On multivariate analysis, CPA was associated with poverty (OR 2.3, 95% CI [0.979, 3.60], p = 0.0006), low-access Black share (OR 3.3, 95% CI [1.18, 5.47], p = 0.002) and urban designation (OR 1.5, 95% CI [1.13, 1.87], p = 0.004). Conclusion: The built-environment and population-level social determinants of health are related to child physical abuse and should influence advocacy and prevention. Level of evidence: Level III. Type of study: Retrospective.

Original languageEnglish
Pages (from-to)106-110
Number of pages5
JournalJournal of Pediatric Surgery
Issue number1
Publication statusPublished - Jan 2023
Externally publishedYes


  • Child physical abuse
  • Food access
  • Social determinants of health
  • Social vulnerability index
  • Trauma


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