Widening Disparities In U.S. Child Maltreatment Fatalities, 2000–2024: A Comparative Analysis of Child Protective Services and CDC Mortality Data

Background:
Child maltreatment fatalities (CMFs) are the most severe outcomes of child abuse and neglect. However, surveillance of CMFs is complicated by differences in case identification and reporting across systems. This study examined disparities in CMFs in the U.S. by race/ethnicity, rurality, age, and sex from 2000 to 2024 using two national data systems and assessed trends and discrepancies over time.

Methods:
We analyzed national CMF data from all 50 states and DC from 2000 to 2024. CPS-investigated CMFs were obtained from the National Child Abuse and Neglect Data System Child Files. CDC mortality data were derived from death certificates 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 (RUC) codes. Child population denominators were obtained from the U.S. Census Bureau. CMF rates were calculated per 1,000,000 children. Disparities were expressed as rate ratios (RRs) with 95% CIs using the log-transformed Wald method.

Results:
Black children consistently experienced substantially higher CMF rates than White children. In CDC data, the Black/White disparity remained stable at approximately 3.3 (95% CI: 2.8–3.8) during 2000–2019 and increased to 4.1 (3.4–4.9) in 2020–2024. In CPS data, the disparity was stable at approximately 2.7 (2.6–2.9) during 2000–2019 and rose to 3.3 (3.2–3.5) in 2020–2024. Native American/White disparities were stable at approximately 3.2 in CDC data during 2000–2019 and increased to 4.7 (2.8–7.6) in 2020–2024, whereas CPS data showed a stable but lower disparity of approximately 1.5. Multi-racial children also showed increasing disparities over time in CPS data, with a recent RR of 1.8 (1.6–2.0) in 2020–2024. Hispanic children had CMF rates similar to White children, while Asian children consistently had 50%–80% lower rates. Rural disparities widened over time. In CDC data, the small urban/large urban RR increased from 1.1 (0.9–1.2) in 2000–2004 to 2.0 (1.7–2.3) in 2020–2024, while the rural/large urban RR increased from 1.1 (1.0–1.3) to 1.8 (1.4–2.2). CPS data showed similar patterns. Male children had consistently higher CMF rates than female children (RR approximately 1.3) across both systems throughout the study period. In CPS data, infants aged <1 year had markedly elevated CMF rates compared with children aged 1–17 years, with the disparity increasing from 11.4-fold (9.7–13.3) in 2000–2002 to approximately 15.5-fold (14.0–17.3) since 2009.

Conclusions/Implications:
CMF disparities by race/ethnicity, rurality, sex, and age remain substantial in the U.S., with several disparities worsening over time. Both CDC and CPS data indicate persistently elevated risks among Black, Native American, and multi-racial children; children in small urban and rural areas; male children; and especially infants. Differences between CDC and CPS estimates for Native American children highlight potential under-ascertainment in CPS systems, particularly in tribal communities. Improved surveillance, stronger cross-system data integration, and targeted prevention strategies are urgently needed to reduce inequities in child maltreatment deaths and better identify high-risk children and communities for early intervention.