INFANT HOMICIDE DATA NAPHSIS / NCHS We measure babies. Our measurements measure us Michael Durfee MD.

INFANT HOMICIDE DATA

NAPHSIS / NCHSWe measure babies.

Our measurements measure us

Michael Durfee MD

My Background Child PsychiatristCareer – Child Abuse Neglect

• Started Child Death Review 1978

• Projects today– Track neonates”at risk, substance abue” – California hospital discharge data - nonfatal review– Infant homicide data - Missing records

Case Example of Child Abuse Data - single case

Ten week old falls from couch to floor Taken to closest hospital in coma

(in a neighboring state)

And… dies

FBI UCR SHR - Dad suspect(Local Police)

Coroner- Undetermined(neighboring state)

Child Abuse Central Index, No Report (Local CPS)

Suspicious Death(local Child Death Review Team)

Team finds CoronerIn neighboring stateTell law enforcement

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Dad convicted but no one reports to social servicesThree siblings left in home

Matching data sets identifies missing recordsSiblings found and served

Vital Statistics + Child Abuse Data can assist each other

• Public Health provide child abuse– Models for population study and surveillance

• We can provide quality control – e.g. possible loss of infant homicide data

LA Coroner Calif VS SUMMARY

year # cases # Cases # missing % missing1999 21 16 5 24%2000 26 7 8 50%2001 24 11 13 54%2002 17 7 12 71%2003 17 6 11 65%2004 16 8 8 50%2005 14 6 8 27%2006 15 11 4 49%

LA County lost cases 1999-2006

Potential explanations

1) Coroner record error (NO - mostly checked)

2) County of residence (NO - too many)

3) Children 1-17 (NO – see table/graph)

4 )Track individual cases

5) Other counties

6) Other states

age 0 9 12 21 13 16 8 791 -1 -1 0 2 -2 -1 -32 0 0 1 0 1 0 23 -1 -1 -1 2 0 1 04 3 2 0 -1 1 0 55 0 0 0 1 0 1 26 0 -1 0 0 1 0 07 1 1 0 1 -1 1 38 0 0 0 0 0 0 09 0 0 0 0 0 0 010 1 -2 0 0 0 0 -111 0 1 -1 -2 0 0 -212 1 1 0 1 0 0 313 2 0 0 0 0 0 214 0 1 1 0 1 0 315 -2 -1 1 0 0 1 -116 3 0 -1 -2 -1 0 -117 -1 1 0 4 1 -1 4

1999 2000 2001 2002 2003 2004YEAR

Cases “lost” by age and year

Infants “lost” and 1-17 “OK”

Next Check

4) Track individual cases

5) Other California Counties

6) Other States

4) Track cases - 24 in 2001Most validated by criminal court

• 24 local to State first run =12, (To be repeated)

• LA County Vital Stats 19 (“state index)”

• State child death 6 – 10 (when E967 removed)

• Summary, Needs to be repeated but all miss cases

5 Other Counties (California)

• Sacramento 50% missing– Years 2003-2005 missing 9/18

• San Bernardino 63% missing– Years 2003-2006 missing 12 of 19

• Orange overall “even” ?– 2002 – 2006 miss 4 of 10, – 1999 - 2001 extra 4 out of 7

6 Other States/Counties

• Some with small loss– Single county (Ohio, SC) and State of Missouri

• Philadelphia County Pa. Missing 42%- 1999- 2005 missing 8 of 19

- Then I stopped, and came to this conference

- All need to resolve this is…

You!

• Track Your • Infant Homicides• 1999 - 2007• Coroner to Vital Stats

• Email data to me or…

History

• 1860 – Ambrose Tardieu described fatal child abuse

• And, almost nothing happened

Current History of Child AbuseLiterature, laws, topics

• 1965 “Child Abuse” to Index Medicus

• 1990s fatal abuse in news and team review

• 2000+ public health arrives

Homicide by Age/Gender(Younger victim about equal)

CHILD HOMICIDE RATE, GENDER/ AGEUNITED STATES 2000Michael Durfee MD, 11/ 25/ 02

0

2

4

6

8

10

12

14

16

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE (YEARS)

RA

TE

Males females

Homicide /Rate /Age /Race(Rates for all ages, not equal)

CHILD HOMICIDE RATE/ RACE/ AGE US 2000

0

5

10

15

20

25

30

35

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

AGE

RA

TE

WHITE BLACK

Infant Rates Constant/Time(Differ from older homicide)

Child Homicide Crude Rate by Age by YearUS Vital Stats WISQARS 1990 - 2001

Michael Durfee MD [email protected] 11/1/03

0

5

10

15

20

25

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

YEAR

<1

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Age in Years

17 y/o

16 y/o

15 y/o

<1 y/o

14 y/o

1 y/o

o

3 y/o4-12 y/o

AB

C

A <1 surpass 15 y/o 1996

B <1 surpass 16 y/o 1998

C <1 "Match/Parallel" 17 y/o 2000-2001

Rate/100,000 births

DF

E

D 1 y/o surpass 14 y/o 1996

E 1 y/o surpass 15 y/o 2001

F 2 y/o surpass 14 y/o 2000

G*

G 3 y/o match 14 y/o 2001

ICD9 1990-1998 ICD10 1999-2001

`

H*

H 4 y/o surpass 13 y/o 2001

13 y/o

DOJ HomicideN=243

VS Injury DeathsN=1165

VS HomicideN=214

VS CANN=90

DOJ CANN=196

DOJ CACIN=128

N=56

Child Abuse and Neglect Fatalities: Children < 6 Years, California 1992-3

Texas - Infant Death Data CPS (CACI) higher,

as expectedTexas Suspicious Infant Death

0

20

40

60

80

Year

De

ath

s

UCR 21 24 18 22 13 17 24 7 24 17 21

VS 20 40 25 26 15 22 20 22 36 26 25 34

CACI 42 35 47 41 59 60 61 75

199 199 199 199 199 199 199 199 199 199 200 200