Child Maltreatment Fatalities In the United States: National Trends and Growing Discrepancies between CPS and Mortality Records, 2002-2024

Background/Purpose:
National Child Abuse and Neglect Data System (NCANDS) and Centers for Disease Control and Prevention (CDC) are the primary national systems used to monitor child maltreatment fatalities (CMFs) in the United States, yet substantial discrepancies between these systems remain poorly understood. This study examined national CMF trends from 2002 to 2024 using these major data systems and assessed gaps across sources overall and by child sex, race/ethnicity, and rurality.

Methods:
We analyzed national CMF data from 2002 to 2024 using: (1) NCANDS Agency Files, which capture all CMFs known to child protective services (CPS), including both investigated and non-investigated fatalities; (2) NCANDS Child Files, which include only CPS-investigated CMFs; and (3) CDC mortality records based on death certificates. NCANDS data identified CMFs resulting from abuse or neglect, either as the direct cause of death or as a contributing factor. CDC CMFs were identified using ICD-10 codes for maltreatment syndromes (T74), neglect and abandonment (Y06), and other maltreatment-related causes (Y07). Rurality was classified using USDA Rural-Urban Continuum codes to examine potential geographic differences in surveillance gaps. Annual CMF rates were calculated per 1,000,000 children using U.S. Census population estimates, with 95% confidence intervals estimated using exact Poisson methods.

Results:
CPS-known CMF rates based on NCANDS Agency Files increased substantially from 17.2 per 1,000,000 children (95% CI: 16.3–18.2) in 2002 to 28.0 (26.8–29.2) in 2022, followed by a modest decline to 24.2 (23.0–25.3) in 2024. CPS-investigated CMF rates based on NCANDS Child Files followed a nearly identical longitudinal pattern and consistently accounted for approximately 80% of all CPS-known CMFs throughout the study period, indicating relative stability in the proportion of CPS-known deaths that underwent formal investigation. In contrast, CDC-based CMF rates declined over time, from 3.3 (2.9–3.7) in 2002 to 1.6 (1.4–2.0) in 2024. Relative to CPS-known CMFs, CDC mortality data captured only about 20% of fatalities in 2002, declining steadily to just 7% in 2024. Compared with CPS-investigated CMFs reported by medical personnel, CDC-based CMFs represented approximately 80% in 2002 but fell to 29% by 2024. These widening discrepancies between CPS and CDC sources were consistent across child sex, race/ethnicity, and rurality, suggesting that under-identification in mortality surveillance is broad-based rather than limited to specific subgroups.

Conclusions/Implications:
National CPS data indicate that CMF rates increased markedly from 2002 through 2024, with only a slight decline in recent years, whereas CDC mortality data suggest a long-term decrease. The growing divergence between CPS and CDC estimates suggests substantial under-detection of CMFs in death certificate-based surveillance, potentially reflecting missed maltreatment coding, inconsistent certifier practices, or structural barriers to identifying abuse and neglect as contributing causes of death. In recent years, CDC mortality data captured fewer than one in ten CPS-known CMFs and fewer than one-third of CPS-investigated CMFs reported by medical personnel. Strengthening coordination between child welfare, medical, and death investigation systems is critical to improving CMF surveillance, guiding prevention efforts, allocating resources, and reducing disparities in child safety outcomes.