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Association of maternal risk factors with infant maltreatment: an administrative data cohort study
  1. Jennifer N Smith1,2,3,
  2. Astrid Guttmann1,2,4,5,
  3. Alexander Kopp4,
  4. Ashley Vandermorris2,6,
  5. Michelle Shouldice1,2,
  6. Katie L Harron3,4,7
  1. 1 Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
  3. 3 The London School of Hygiene and Tropical Medicine (affiliated at the time of acquiring REB approval), London, UK
  4. 4 ICES, Toronto, Ontario, Canada
  5. 5 Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
  6. 6 Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  7. 7 UCL Great Ormond Street Institute of Child Health, London, UK
  1. Correspondence to Professor Katie L Harron, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; k.harron{at}ucl.ac.uk

Abstract

Objective We aimed to evaluate the risk of infant maltreatment associated with commonly used criteria for home visiting programmes: young maternal age, maternal adversity (homelessness, substance abuse, intimate partner violence), newcomer status and mental health concerns in Ontario, Canada.

Design This retrospective cohort study included infants born in hospital in Ontario from 1 April 2005 to 31 March 2017 captured in linked health administrative and demographic databases. Infants were followed from newborn hospitalisation until 1 year of age for child maltreatment captured in healthcare or death records. The association between type and number of maternal risk factors, and maltreatment, was analysed using multivariable logistic regression modelling, controlling for infant characteristics and material deprivation. Further modelling explored the association of each year of maternal age with maltreatment.

Results Of 989 586 infants, 434 (0.04%) had recorded maltreatment. Maternal age <22 years conferred higher risk of infant maltreatment (adjusted OR (aOR) 5.5, 95% CI 4.5 to 6.8) compared with age ≥22 years. Maternal mental health diagnoses (aOR 2.0, 95% CI 1.6 to 2.5) were also associated with maltreatment, while refugee status appeared protective (aOR 0.6, 95% CI 0.4 to 1.0). The odds of maltreatment increased with higher numbers of maternal risk factors. Maternal age was associated with maltreatment until age 28 years.

Conclusion Infants born to young mothers are at greater risk of infant maltreatment, and this association remained until age 28 years. These findings are important for ensuring public health interventions are supporting populations experiencing structural vulnerabilities with the aim of preventing maltreatment.

  • Child Abuse
  • Child Welfare
  • Child Health Services
  • Mental health
  • Child Protective Services

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Contributors JNS conceptualised and designed the study, interpreted the results, drafted the initial manuscript and revised the manuscript. AG, KLH, AV and MS conceptualised and designed the study, interpreted the results and drafted the manuscript. AK was involved in the design of the study, had access to and analysed the data, interpreted the results and drafted the manuscript. KLH is guarantor.

  • Funding This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by: MOH, MLTC, Canadian Institute for Health Information (CIHI), and Immigration, Refugees Citizenship Canada (IRCC). Parts of this report are also based on Ontario Registrar General (ORG) information on deaths, the original source of which is ServiceOntario. KLH is supported by funding from the National Institute of Health Research (NIHR 17/99/19). This research was supported in part by the NIHR Great Ormond Street Hospital Biomedical Research Centre and the Health Data Research UK (grant no. LOND1), which is funded by the UK Medical Research Council and eight other funders. AG is funded by a Tier 1 Canada Research Chair in child health services and policy.

  • Disclaimer The analyses, conclusions, opinions and statements expressed here are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The views expressed are those of the authors and do not necessarily reflect those of ORG or Ministry of Government Services.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.