Widening Rural-Urban Disparities In Child Maltreatment Report Rates In the United States, 2009–2023

Background

Although prior research has documented rural-urban differences in child maltreatment, less is known about whether these disparities have changed over time and how much they are driven by underlying socioeconomic and demographic conditions. Examining these patterns is critical for identifying whether rural communities are becoming increasingly disadvantaged and for informing place-based prevention strategies. This study examined rural-urban disparities in county-level child maltreatment report (CMR) rates in the United States from 2009 to 2023 and assessed the extent to which these disparities and their changes over time were explained by county socioeconomic and demographic characteristics.

Methods

We analyzed county-year panel data for counties in all 50 states and the District of Columbia from 2009 to 2023. CMR data were obtained from the NCANDS Child Files. County rurality was classified using the USDA Rural-Urban Continuum Codes. County-level socioeconomic indicators included child poverty, single-parent households, adults without a high school degree, unemployment, median home values, and owner-occupied housing. Demographic characteristics included percentages of Black residents, Latino residents, foreign-born residents, children, older adults, male adults, and residents who had moved in the past year. Covariates were derived from the American Community Survey. Multilevel linear models with county- and state-level random intercepts were estimated to assess rurality differences across three five-year periods (2009–2013, 2014–2018, and 2019–2023), with sequential adjustment for socioeconomic and demographic characteristics.

Results

Rural-urban disparities in CMR rates widened substantially over time. In unadjusted models, compared with large urban counties, CMR rates were 4% higher in small urban counties (p=.021) and 18% higher in rural counties (p<.001) during 2009–2013. These disparities increased over time: during 2014–2018, rates were 7% higher in small urban counties (p<.001) and 26% higher in rural counties (p<.001); during 2019–2023, rates were 11% higher in small urban counties (p<.001) and 32% higher in rural counties (p<.001). Socioeconomic conditions explained a substantial share of these disparities. After adjustment for socioeconomic factors, rural/large-urban differences were reduced to 11%, 19%, and 20% across the three periods, respectively, while small-urban/large-urban differences were also attenuated. Additional adjustment for demographic characteristics largely explained small-urban/large-urban disparities and further reduced rural/large-urban gaps. In fully adjusted models, rural counties still had modestly higher CMR rates than large urban counties in 2014–2018 (5%, p=.007) and 2019–2023 (7%, p=.001), but the majority of the widening disparity was accounted for by differences in socioeconomic and demographic conditions.

Conclusions/Implications

Rural-urban disparities in CMR rates widened over the past fifteen years, indicating growing geographic inequities in child maltreatment risk and child welfare system involvement. Most of this widening gap was explained by socioeconomic and demographic differences, suggesting that reducing disparities will require addressing structural drivers related to these factors. The modest remaining rural disadvantage suggests that other place-based factors, such as service availability, workforce shortages, transportation barriers, and reporting infrastructure, may also contribute. Reducing geographic disparities will likely require both broad investments in socioeconomic conditions and targeted strategies tailored to rural communities.