1. INFANT HOMICIDE DATA NAPHSIS / NCHS We measure babies. Our measurements measure us Michael Durfee MD

2. My Background Child Psychiatrist Career – Child Abuse Neglect Started Child Death Review 1978 Projects today –Track neonates”at risk, substance abue” –California hospital discharge data - nonfatal review –Infant homicide data - Missing records

3. Case Example of Child Abuse Data - single case Ten week old falls from couch to floor Taken to closest hospital in coma (in a neighboring state) And… dies

4. FBI UCR SHR - Dad suspect (Local Police) Coroner- Undetermined (neighboring state) Child Abuse Central Index, No Report (Local CPS) Suspicious Death (local Child Death Review Team)

5. Team finds Coroner In neighboring state Tell law enforcement `

6. Dad convicted but no one reports to social services Three siblings left in home

7. Matching data sets identifies missing records Siblings found and served

8. Vital Statistics + Child Abuse Data can assist each other Public Health provide child abuse –Models for population study and surveillance We can provide quality control –e.g. possible loss of infant homicide data

9. LA CoronerCalif VSSUMMARY year# cases# Cases# missing% missing 19992116524% 2000267850% 200124111354% 20021771271% 20031761165% 2004168850% 2005146827% 20061511449% LA County lost cases 1999-2006

10. Potential explanations 1) Coroner record error (NO - mostly checked) 2) County of residence (NO - too many) 3) Children 1-17 (NO – see table/graph) 4 )Track individual cases 5) Other counties 6) Other states

11. age0912211316879 1 02-2-3 20010102 3 2010 4320 105 50001012 60 00100 71101 13 80000000 90000000 101-20000 1101-200 121101003 132000002 140110103 15-21001 1630-20 171041 4 199920002001200220032004 YEAR Cases “lost” by age and year

12. Infants “lost” and 1-17 “OK”

13. Next Check 4) Track individual cases 5) Other California Counties 6) Other States

14. 4) Track cases - 24 in 2001 Most validated by criminal court 24 local to State first run =12, (To be repeated) LA County Vital Stats 19 (“state index)” State child death 6 – 10 (when E967 removed) Summary, Needs to be repeated but all miss cases

15. 5 Other Counties (California) Sacramento 50% missing –Years 2003-2005 missing 9/18 San Bernardino 63% missing –Years 2003-2006 missing 12 of 19 Orange overall “even” ? –2002 – 2006 miss 4 of 10, –1999 - 2001 extra 4 out of 7

16. 6 Other States/Counties Some with small loss –Single county (Ohio, SC) and State of Missouri Philadelphia County Pa. Missing 42% -1999- 2005 missing 8 of 19 -Then I stopped, and came to this conference -All need to resolve this is…

17. You! Track Your Infant Homicides 1999 - 2007 Coroner to Vital Stats Email data to me or…

18. History 1860 – Ambrose Tardieu described fatal child abuse And, almost nothing happened

19. Current History of Child Abuse Literature, laws, topics 1965 “Child Abuse” to Index Medicus 1990s fatal abuse in news and team review 2000+ public health arrives

20. Homicide by Age/Gender (Younger victim about equal)

21. Homicide /Rate /Age /Race (Rates for all ages, not equal)

22. Infant Rates Constant/Time (Differ from older homicide)

23. DOJ Homicide N=243 VS Injury Deaths N=1165 VS Homicide N=214 VS CAN N=90 DOJ CAN N=196 DOJ CACI N=128 N=56 Child Abuse and Neglect Fatalities: Children < 6 Years, California 1992-3

24. Texas - Infant Death Data CPS (CACI) higher, as expected