Statement of Purpose Child maltreatment has lifelong impacts on health and well-being, which can result in serious injuries and death. The objective of this study was to identify the incidence and risk factors of child maltreatment-related injuries resulting in hospitalizations for children under three for the population of Washington State.

Methods/Approach A prospective cohort study utilizing retrospective linked administrative data for all children born in Washington State between 1999 and 2013 (N=1,271,419). The data set comprised of linked birth discharge and hospitalization records for the entire state. Child maltreatment-related hospitalizations were identified using ICD-9 codes, both specifically attributed to and suggestive of maltreatment. Incidence rates were calculated for the overall population, by year, sex, maltreatment type, and child age. Risk and protective factors were identified using hierarchical linear modeling to test community-level poverty/disadvantage simultaneously with sociodemographic variables from the birth record.

Results A total of 4,078 hospitalizations related to child maltreatment were identified for an incidence rate of 3.21 per 1,000 births. More than half of all hospitalizations were related to neglect. Children whose mother resided in a census tract with high concentrated disadvantage at the time of the child’s birth experienced child maltreatment-related hospitalizations at 1.2 times the rate of children who did not reside in high concentrated disadvantage census tracts.

Conclusions Hospitalizations can be a useful source of population-based child maltreatment surveillance.

These population-based data suggest that the community context, in addition to individual-level factors, contributes to the risk of a child being hospitalized for child maltreatment-related reasons.

Significance and Contributions to Injury and Prevention Science The identification of neglect-related hospitalizations as the most common sub-type, and likely the result of supervisory neglect, are important findings for the development and implementation of prevention programming.