Geographic patterns of fatal abuse or neglect in children younger than 5 years old, United States, 1979 to 1988.

OBJECTIVE: To examine geographic patterns of fatal child abuse or neglect (CAN) among children younger than 5 years old. DESIGN: A death certificate-based model to estimate the occurrence of fatal CAN. SETTING: United States, 1979 to 1988. PARTICIPANTS: The population of children younger than 5 years old. INTERVENTIONS: None. MAIN RESULTS: We estimate that from 868 to 1815 deaths annually occur among children younger than 5 years old from CAN. The lower figure is the estimate of confirmed CAN, and the higher is the estimate of the sum of confirmed, probable, and possible CAN. Death rates were highest in the South and West, intermediate in the North Central, and lowest in the Northeast. A threefold difference was noted between rates in the lowest- and highest-ranking states (ie, Connecticut, 2.9 to 5.2 per 100,000, and Nevada, 6.7 to 15.4 per 100,000, respectively). When the 39 largest metropolitan areas were ranked, a similar variation between the lowest and the highest was observed (ie, Boston, Mass, 2.7 to 5.5 per 100,000, and Phoenix, Ariz, 6.6 to 15.5 per 100,000, respectively). CONCLUSION: Understanding the sizable geographic variation in CAN deaths rates could lead to effective interventions. If the US fatality rate were reduced to that of Connecticut, between 434 and 908 fewer CAN deaths might occur annually.