Urban-Rural Residence and Child Physical Abuse Hospitalizations: A National Incidence Study

Research Brief

Puls, H. T., Bettenhausen, J. L., Markham, J. L., Walker, J. M., Drake, B., Kyler, K. E., Queen, M. A., & Hall, M. (2019). Urban-Rural Residence and Child Physical Abuse Hospitalizations: A National Incidence Study. The Journal of Pediatrics, 205, 230–235. https://doi-org.ezp.slu.edu/10.1016/j.jpeds.2018.09.071

What we know

Child physical abuse is a major public health concern in every community in the United States. However, there is an unequal distribution of risk factors for child physical abuse across urban and rural communities. For instance, rural areas are more likely to be poor and have higher rates of teen pregnancy, both risk factors for physical abuse. Yet, racial and ethnic minority children are more likely to live in urban areas and more likely to be victims of all forms of abuse and neglect.  Because urban and rural populations vary demographically, socially, and economically in important ways, it is unknown how rates of child physical abuse vary between urban and rural areas. Properly identifying those most vulnerable to child physical abuse can help service providers and government agencies better focus prevention efforts and resources, for both big cities and rural communities.

What the study adds

The authors found no relationship between rates of severe child physical abuse that requires hospitalization and whether a child lived in a rural or urban area. In other words, hospitalization rates for physical abuse were similar regardless of where a child lived. Nevertheless, rates for Black children were disproportionate to that of white children, with this disproportionality increasing with population density. Overall, 2,082 child physical abuse hospitalizations were identified among a population of 18.2 million. The study’s research found persistent support for the “Hispanic Paradox” across the urban-rural spectrum and for child physical abuse; Despite their high poverty rates, there were proportionately fewer Hispanic children severely abused.

Practice or policy implications

The authors conclude that urban Black children were exposed to unique, undetermined circumstances, in addition to poverty, that increase their risk for physical abuse hospitalization. They assert that these unique exposures must be identified in future research so that we can focus specific support and resources to address and reduce the black-white disproportionality in child physical abuse.


The study used a retrospective, cross-sectional design to describe 2012 data from the Kids’ Inpatient Database and the American Community Survey, which surveys 4100 hospitals across the United States. The databases contain around 3 million pediatric discharge records. The population was Black, Hispanic, and non-Hispanic White children that were less than five-years-old and living in US counties. The analyses were adjusted for poverty and racial and ethnic demographics.