CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026
Hospital admissions for maltreatment among children younger than 2 years during the COVID-19 pandemic in Canada.
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Carwana Matthew, Roumeliotis Nadia, Dean Paige, Braschel Melissa, Trudeau-Ferrin Ofelie, Udall Britt, Benigeri Mike, Diop Mamadou, Kang Kris, Jain Nita, Forgeot-d'Arc Baudouin, Ali Samina, Banerjee Ananya, Drouin Olivier, Fontela Patricia, Gantt Soren, Gill Peter, Guttmann Astrid, Li Patricia, Mahant Sanjay, Papenburg Jesse, Sadarangani Manish, Wahi Gita, Zinszer Kate, Kellner James D, Côté Sylvana M, Quach Caroline, Doan Quynh, POPCORN Investigators
Аннотация
BACKGROUND: Early evidence suggested an increase in child maltreatment during the COVID-19 pandemic. We sought to assess changes in the incidence rate of hospital admission for maltreatment among children younger than 2 years during the COVID-19 pandemic.
METHODS: We conducted a pan-Canadian population-based interrupted time-series analysis from Apr. 3, 2016, to Mar. 25, 2023. We obtained administrative health data from the Canadian Institute for Health Information and the Institut national d'excellence de santé et services sociaux for all Canadian provinces and territories. The primary exposure was the COVID-19 pandemic period compared with the prepandemic period. The primary outcome was hospital admission for child maltreatment, and the secondary outcome was intensive care unit (ICU) admission for the same diagnosis. We compared incidence rates between the prepandemic and COVID-19 pandemic periods.
RESULTS: A total of 1518 hospital admissions for maltreatment occurred among children younger than 2 years. We found a 31% reduction in hospital admissions over 16 weeks at the beginning of the pandemic (adjusted rate ratio 0.69, 95% confidence interval [CI] 0.58 to 0.83) and a 56% reduction in ICU admissions (adjusted rate ratio 0.44, 95% CI 0.25 to 0.78). The rate of hospital admission returned to baseline, but the rate of ICU admission increased following the 16-week period of restricted health care access (adjusted rate ratio 1.80, 95% CI 1.23 to 2.63).
INTERPRETATION: Initial public health measures and restricted health care access during the pandemic were associated with decreased rates of hospital admission for child maltreatment. We found no sustained reduction in overall hospital admission rates throughout the remaining pandemic period, but admissions to ICU increased. Our findings suggest that public health measures during the pandemic resulted in decreased detection of child maltreatment and possibly increased severity of cases involving hospital admission, suggesting a need for greater attention to identification and treatment of child maltreatment in future pandemic settings.
METHODS: We conducted a pan-Canadian population-based interrupted time-series analysis from Apr. 3, 2016, to Mar. 25, 2023. We obtained administrative health data from the Canadian Institute for Health Information and the Institut national d'excellence de santé et services sociaux for all Canadian provinces and territories. The primary exposure was the COVID-19 pandemic period compared with the prepandemic period. The primary outcome was hospital admission for child maltreatment, and the secondary outcome was intensive care unit (ICU) admission for the same diagnosis. We compared incidence rates between the prepandemic and COVID-19 pandemic periods.
RESULTS: A total of 1518 hospital admissions for maltreatment occurred among children younger than 2 years. We found a 31% reduction in hospital admissions over 16 weeks at the beginning of the pandemic (adjusted rate ratio 0.69, 95% confidence interval [CI] 0.58 to 0.83) and a 56% reduction in ICU admissions (adjusted rate ratio 0.44, 95% CI 0.25 to 0.78). The rate of hospital admission returned to baseline, but the rate of ICU admission increased following the 16-week period of restricted health care access (adjusted rate ratio 1.80, 95% CI 1.23 to 2.63).
INTERPRETATION: Initial public health measures and restricted health care access during the pandemic were associated with decreased rates of hospital admission for child maltreatment. We found no sustained reduction in overall hospital admission rates throughout the remaining pandemic period, but admissions to ICU increased. Our findings suggest that public health measures during the pandemic resulted in decreased detection of child maltreatment and possibly increased severity of cases involving hospital admission, suggesting a need for greater attention to identification and treatment of child maltreatment in future pandemic settings.