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 negl ect (CAN) among children younger than 5 years old. Design: A death cer tificate-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 Result: We estima te that from 868 to 1815 deaths annually occur among children younger than 5 years old from CAN. The lower figure is the estimate of confirm ed CAN, and the higher is the estimate of the sum of confirmed, probab le, and possible CAN. Death rates were highest in the South and West, intermediate in the North Central, and lowest in the Northeast. A thre efold difference was noted between rates in the lowest- and highest-ra nking states (ie, Connecticut, 2.9 to 5.1 per 1 00 000, 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 hig hest was observed (ie, Boston, Mass, 2.7 to 5.5 per 100 000, and Phoen ix, Ariz, 6.6 to 15.5 per 100 000, respectively). Conclusion: Understa nding the sizable geographic variation in CAN deaths rates could lead to effective interventions. If the US fatality rate were reduced to th at of Connecticut, between 434 and 908 fewer CAN deaths might occur an nually.