QUANTIFYING METHODOLOGICAL CHALLENGES IN POPULATION-REPRESENTATIVE CHILD MALTREATMENT RESEARCH THROUGH NOVEL DATA LINKAGES AND OUTCOME CLASSIFICATION

Abstract

Background: Conducting epidemiologic research on a population basis is critical to understanding the magnitude of, and factors contributing to, child maltreatment. Large scale data linkage projects combining statewide birth records with child protective services records is a promising strategy to study maltreatment in a population. This project combines population-representative epidemiologic survey and administrative sources to estimate maltreatment incidence, and measure error resulting from poor linkage quality, limited cohort follow-up, and outcome ascertainment common in linkage studies. Methods: Respondent data from the 2009 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) were linked with multiple administrative sources. To ascertain maltreatment reports we linked with child protective services (CPS), child advocacy center (CAC), Anchorage Police Department (APD), and child death review (CDR) records. A sub-study of all mortality among the 2009 and 2010 birth cohort was conducted to measure the reliability of maltreatment determinations made by the Alaska CDR. Results: The 2009 PRAMS respondents represent 11% of all resident live births in Alaska. Nearly 4% of the PRAMS respondents were censored annually; censoring was due to out-of-state emigration (n=237, 20%w) and deaths from competing causes (n=18, 0.7%w). Before age six years, 28%w (95%CI 24%w, 33%w) of Alaskan children born in 2009 were the subject of a maltreatment report to CPS, CAC, APD, or CDR. Failure to account for emigration or using stringent linkage assumptions would bias the risk estimate downwards by 12% and 43%, respectively. Agreement of maltreatment classifications between CDR panels was substantial for abuse but only fair for neglect and negligence. Multiple factors influenced discordant classification. Discussion: Linking PRAMS with administrative data allows researchers to conduct high quality research to estimate, at low cost, the risk of a maltreatment report longitudinally in a population-representative sample. The completeness of follow-up in this cohort is high, particularly for non-military births. While Alaska has unique administrative sources that allow for more comprehensive follow-up, other states could implement similar methods to better understand incidence of, and risk factors contributing to, maltreatment reports. However, to be worthwhile, improvements in maltreatment ascertainment are needed. The CDR model may be useful but not without standardized decision guidance.Doctor of Philosoph