Upsurging of child maltreatment admissions in Chinese by using ICD codes for maltreatment syndrome: A different experience in the East

We appreciate Gonzalez-Izquierdo's detailed analysis and the enlightening discussion on variation in recording of child maltreatment admissions. We are particularly interested in its conclusion that the overall burden throughout the years has remained stable. In this first reported database of child maltreatment admissions in Chinese population, we have a very different conclusion and found a definite trend of upsurging of child maltreatment admissions and increasing burden by only including the ICD 9-CM codes for maltreatment syndrome.

As there is a gap of knowledge on incidence of child maltreatment admissions in Chinese population, we recently conduct a study by searching all children (<19) admissions in the Hong Kong Hospital Authority database through the computerized Clinical Data Retrieval System. With the advancement in information technology and the full implementation of electronic record system in all Hong Kong public hospitals since late 2000, we successfully evaluate all hospital admissions recorded by ICD 9- CM codes for child maltreatment syndrome. From 1st Jan 2001 to 31st Dec 2008, there were 5430 admissions discharged with a diagnosis under ICD codes for maltreatment syndrome. In contrast to the significant decline in annual incidence of admissions with codes for child maltreatment syndrome in Gonzalez-Izquierdo's study in England, we found a very different pattern with an upsurging of admissions with codes for maltreatment syndrome. Considering the effect of the changes in childhood population during the study period, the annual incidence rates were calculated by dividing the number of admissions coded for child maltreatment syndrome by age-specific population estimates for each calendar year. The annual incidence followed an almost linear curve and increased by 125%, from 32.5 per 100,000 in 2001 to 73.2 per 100,000 in 2008 (R-square = 0.96, p < 0.0001). This trend of increase in annual incidence of child maltreatment is also confirmed by another set of official data reported to the Child Protection Registry(CPR) of Hong Kong government, when the annual incidence increased by 65% from 2001 to 2008 [1]. This difference in percentage of increase in incidence between our hospital database and the government CPR may be due to a more stringent practice adopted by the latter, different nature of cases handled and difference in counting of re -admission or re-abused cases. In spite of the similarity in Hong Kong hospital admission and child protection system under the influence of previous British governance, we have found a very different pattern from Britain in this developed city in the East by using the ICD codes for maltreatment syndrome. The upsurge of child maltreatment admissions in Hong Kong may reflect a true increase in incidence of abuse cases or an increase reporting rate due to increased coverage in media and publicity of child abuse prevention and help-seeking and lower thresholds for coding maltreatment. This warrants further investigation to delineate the causes and recommend appropriate preventive strategies. Gonzalez-Izquierdo's robust analysis is inspiring and the phenomenon of under-reporting of child maltreatment in health care database should also be applicable to Hong Kong. Codes for maltreatment-related features should be included in future analysis in order to clarify the picture and achieve a more reliable estimate of the overall burden.

Ref 1) Child Protection Registry 2009. Social Welfare Department, The Hong Kong Government Special Administrative Region. Available at http://www.swd.gov.hk/vs/english/stat.html

Conflict of Interest:

None declared