Hospitalisations for physical abuse in infants and children less than 5 years, 2013-2021: a multinational cohort study using administrative data from five European countries

BACKGROUND: Child physical abuse (CPA) is a global public health problem associated with lifelong negative consequences, yet reliable epidemiologic data are lacking. This multinational cohort study analyses trends in CPA hospitalisations from 2013 to 2021.

METHODS: We used medico-administrative databases to identify children aged one month to five years hospitalised in Denmark, England, France, Ireland, and Wales. We identified CPA using a validated algorithm based on ICD-10 codes. We calculated the number, proportion, and incidence rate of children hospitalised for CPA, and the number and proportion of total hospitalisations for CPA, by year and age group (<1 and <5). We determined the proportion of CPA hospitalisations recorded using different ICD-10 codes, by country.

FINDINGS: The pooled incidence rate of infants <1 year hospitalised for CPA was stable over time (around 42/100,000 per year), ranging on average from 33 to 48/100,000 between countries. The pooled proportion of infant hospitalisations for CPA was around 0.17% (N = 750) per year (range 0.15-0.21%, N range 674-785), increasing significantly during the COVID-19 pandemic in 2020 (0.21%, N = 674). In children <5, the incidence rate (around 18/100,000 per year) and proportion of CPA hospitalisations (around 0.11% per year (N = 1600), range 0.10-0.14% (N range 1341-1657) were lower than in infants, but also increased in 2020 (0.14%, N = 1341). There were national differences in the distribution of ICD-10 codes used to record CPA and differences in year-on-year trends between countries.

INTERPRETATION: Comparing temporal trends in CPA hospitalisations between countries is feasible. Hospital data are one of several valuable sources for CPA surveillance.

FUNDING: European COST Action EURO-CAN. European Union (HORIZON Europe SERENA project).