RISK-FACTORS FOR INFANT HOMICIDE IN THE UNITED-STATES

Background Homicide is the leading cause of infant deaths due to injur y. More than 80 percent of infant homicides are considered to be fatal child abuse. This study assessed the timing of deaths and risk factor s for infant homicide. Methods Using linked birth and death certificat es for all births in the U.S, between 1983 and 1991, we identified 277 6 homicides occurring during the first year of life. Birth-certificate variables were reviewed in both bivariate and multivariate stratified analyses. Variables potentially predictive of homicide were selected on the basis of increased relative risks among subcategories with adeq uate numbers for stable estimates, Results Half the homicides occurred by the fourth month of life, The most important risk factors were a s econd or subsequent infant born to a mother less than 17 years old (re lative risk, 10.9) or 17 to 19 years old (relative risk, 9.3), as comp ared with a first infant born to a mother 25 years old or older; a mat ernal age of less than 15 years, as compared with an age of at least 2 5 years (relative risk, 6.8); no prenatal care as compared with early prenatal care (relative risk, 10.4); and less than 12 years of educati on among mothers who were at least 17 years old (relative risk, 8.0), as compared with 16 or more years of education. Conclusions Childbeari ng at an early age was strongly associated with infant homicide, parti cularly if the mother had given birth previously. Our findings may hav e implications for prevention. (N Engl J Med 1998;339:1211-6.) (C) 199 8. Massachusetts Medical Society.