suspicious infant death
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Suspicious Infant Death. - PowerPoint PPT PresentationTRANSCRIPT
Suspicious Infant Death
A Proposed
National Data Set
Michael Durfee MD
APHA 2004
Based on Data Match X3+and… “LA Model”
• Data Match X3+– 1 FBI UCR SHR (Cop Homicide)– 2 Vital Statistics (Coroner Homicide)– 3 Child Abuse Central Index (CPS)– + Child Death Review Team
• LA Model – infants only (from above)
State C hi l d D e athR e po r ts C as e s to
l o c al t e am s
FB I - UC R -S HRV I TA L
S TA TI S TI C S
C HILD A B US EC EN TR A L IN D EX
LO C A L A G E N C IE S
L O C AL TE AM SR E C O N C IL E /C O R R E C T
C ASE D ATA
Matching Data Sets Connect…`
• Professions – – Justice– Health– CPS
• More powerful data• State/local agencies
Case Example of Data MatchResolves the “Puzzle”
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
`
Dad convicted but no one reports to social servicesThree siblings left in home
Matching data sets identifies missing recordsSiblings found and served
State C hi l d D e athR e po r ts C ase s to
l o c al t e am s
FB I - UC R -S H RV I TA L
S TA TI S TI C S
C HILD A B US EC EN TR A L IN D EX
LO C A L A G E N C IE S
L O C AL TE AM SR E C O N C IL E /C O R R E C T
C ASE D ATA
C as e e nte r e d i nto C AC I
Si bl i ng s Se r ve d
Why Only Infant Cases
• Manageable with present resources– <12 cases/year for most states – existing data (X3)– Avoid Extra Codes
• Infant homicides are significant – 95%+ by caretaker – 40% of all caretaker homicide– Problem cases for adult oriented systems
Studies - Single Data Sets
Infant Homicide Rate / 100,000 births 1999-2001 (States over 50,000 births)
0.05.0
10.015.020.0
MIS
SO
UR
I
IND
IAN
A
ILLI
NO
IS
VIR
GIN
IA
MIC
HIG
AN
WIS
CO
NS
I
KE
NTU
CK
NO
RTH
TEX
AS
NE
W Y
OR
K
NE
W
MIN
NE
SO
T
WA
SH
ING
T
States
State Infant Homicide Rates Vary up to 400%
State Infant Homicide RatesCorrelate with…
• Infant mortality rates– Pearson r = 0.79 with p <0.0001
• Quality of investigation– Missouri has systematic investigation– LA County changed cases to homicide
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/oo
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
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 17AGE (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 17AGE
RA
TE
WHITE BLACK
Match Infant Data X3(ican-ncfr.org)
Texas - Suspicious Infant Death Rate/Year (X3)
(CPS cases higher – expected)Texas Suspicious Infant Death
0
20
40
60
80
Year
Dea
ths
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
California Infant Homicide Rate/Year
(CPS low - missed data entries)California Suspicious Infant Death
0
20
40
60
80
Year
Dea
ths
SHR 46 56 58 33 49 53 46 39 37 29 30
VS 40 50 41 37 52 41 35 36 36 30 26 24
CACI 15 15
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
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
LA MODELCASE DATA MATCH
LA Model Sample Case
• 3 month male father threw against wall• “Manner” of death X3
– Homicide (UCR and VS) no record CPS• Action
– Father convicted– Case reported to CACI – CPS records found in two counties
• Counties meet to share data• Siblings located, with mom, voluntary services
National Infant Data X3+
• National data with common language– Teams could compare data and cases
(e.g., State infant homicide rates)– Connect cases across state/county lines
• Support more complex data systems– CDC National Violent Death
Child death indices
Resources
• Web Site - ican-ncfr.org– Team Reports– “51 State” Comparison– Infant Data x3 / State– LA Model – 2005
• APHA Caucus on Family Violence– [email protected]