Analysis of National Empirical Data on the Characteristics and Trends of Injury among Taiwan's Victims of Hospitalized Child Abuse between 1997 and 2009

Article excerpt

Objective: To investigate the characteristics and trends of injury among hospitalized child abuse children younger than 18 years between 1997 and 2009. Methods: We selected hospitalized child abuse cases from the Taiwan's National Health Insurance (NHI) Database in accordance with ICD-9-CM 995.5x or E967.x. Results: There were 1,212 victims of hospitalized child abuse during the research period, including 735 boys and 477 girls. The victims were most frequently inflicted by the father or stepfather, and the most common injury was intracranial damage; besides, the victims most commonly sought treatment in medical centers. Infants younger than 1 year accounted for the highest percentage of hospitalized victims. Although there were no apparent trends in the overall hospitalization rate of the child abuse victims over the 13-year period, the rate of abuse among girls increased gradually over the years. Conclusions: The medical staffin hospitals should provide appropriate treatment to the victims and contact relevant organizations to intervene; moreover, government agencies should formulate effective control measures to develop a safe growth environment for children.

Keywords: child abuse; injury; National Health Insurance Research Database; Taiwan, hospitalization rate, medical use

In recent years, child abuse had grown to become a severe social problem globally (World Health Organization, 2006). A United Nations Children's Fund (UNICEF) report revealed that in industrialized countries, 3,500 children abuse deaths less than 15 years every year (UNICEF, 2003). In Taiwan, according to the domestic violence statistics reported by the Ministry of the Interior, there were 16,989 child and juvenile protection cases in 2008 (Domestic Violence and Sexual Assault Prevention Committee, Ministry of Interior, ROC, 2010). In addition, previous studies pointed out that child younger than 4 years were the most vulnerable to death resulting from abuse (Chang et al., 2004; Forjuoh, 2000; World Health Organization, 2002).

In Taiwan, few studies focused on child maltreatment by using a nationwide population-based database (Chiang, Huang, Feng, & Lu, 2012; Chun, Chiu, Pai, & Chien, 2010). Chiang's research showed that the incidence of hospitalization coded as "because of child maltreatment" differed by age groups, and infants had the highest and the largest increase in incidence during 1996-2007 (Chiang et al., 2012); however, it had no attention paid to the medical use of hospitalized child abuse. Thus, this study examined data from the National Health Insurance (NHI) database to investigate the characteristics (including demographic, injury type, and medical use) and trends of injury among hospitalized child abuse children younger than 18 years between 1997 and 2009.

METHODS

Research Materials

This study used data from Taiwan's NHI database collected from 1997 to 2009. The use of the data was approved by the Professional Peer Reviewer Committee. Because the patients remained anonymous, this study did not infringe on patient privacy and was therefore in compliance with the Declaration of Helsinki. Taiwan had an NHI acceptance rate of more than 99%. The NHI database was the empirical information representative of Taiwan (National Health Research Institutes, 2011); as such, it contained information about hospitalized patients and medical professionals in various medical institutions.

The ICD-9-CM (International Classification of Diseases, 9th revision, Clinical Modification) N-Code (nature of injury code) is a classification system for the diagnosis of diseases and injuries, and E-Code (external causes of injury code) is a classification system for the causes of injuries. The NHI database in Taiwan employed an ICD-9-CM coding system, which offered one N-Code for primary diagnosis and four N-Codes for secondary diagnosis. To code injury causes, the database provided an E-Code for primary diagnosis and an E-Code for secondary diagnosis. …