BACKGROUND Child maltreatment is a pressing social problem in the USA and internationally. There are increasing calls for the use of a public health approach to child maltreatment, but the effective adoption of such an approach requires a sound foundation of epidemiological data. This study estimates for the first time, using national data, total and type-specific official maltreatment risks while simultaneously considering environmental poverty and race/ethnicity. METHODS National official maltreatment data (2009-13) were linked to census data. We used additive mixed models to estimate race/ethnicity-specific rates of official maltreatment (total and subtypes) as a function of county-level child poverty rates. The additive model coupled with the multilevel design provided empirically sound estimates while handling both curvilinearity and the nested data structure. RESULTS With increasing county child poverty rates, total and type-specific official maltreatment rates increased in all race/ethnicity groups. At similar poverty levels, White maltreatment rates trended higher than Blacks and Hispanics showed lower rates, especially where the data were most sufficient. For example, at the 25% poverty level, total maltreatment report rates were 6.91% [95% confidence interval (CI): 6.43%-7.40%] for Whites, 6.30% (5.50%-7.11%) for Blacks and 3.32% (2.88%-3.76%) for Hispanics. CONCLUSIONS We find strong positive associations between official child maltreatment and environmental poverty in all race/ethnicity groups. Our data suggest that Black/White disproportionality in official maltreatment is largely driven by Black/White differences in poverty. Our findings also support the presence of a 'Hispanic paradox' in official maltreatment, where Hispanics have lower risks compared with similarly economically situated Whites and Blacks.

中文翻译：

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在美国，虐待儿童的风险取决于贫穷和种族/民族。

背景技术虐待儿童是在美国和国际上紧迫的社会问题。越来越多的人要求使用公共卫生方法来处理虐待儿童的问题，但是有效地采用这种方法需要流行病学数据的坚实基础。这项研究首次使用国家数据估算了总的和特定类型的官方虐待风险，同时考虑了环境贫困和种族/民族。方法将国家官方虐待数据（2009-13年）与人口普查数据相关联。我们使用加性混合模型来估计特定于种族/族裔的官方虐待率（总数和亚型）与县级儿童贫困率的关系。加性模型与多级设计相结合，在处理曲线线性和嵌套数据结构的同时，提供了根据经验得出的合理估计。结果随着县儿童贫困率的上升，所有种族/族裔群体的总虐待和特定类型的官方虐待率都在增加。在类似的贫困水平下，白人的受虐率趋于高于黑人，而西班牙裔的受虐率则更低，尤其是在数据最充分的地方。例如，在25％的贫困水平下，白人的总虐待报告率为6.91％[95％置信区间（CI）：6.43％-7.40％]，黑人为6.30％（5.50％-7.11％）和3.32％（ 2.88％-3.76％）。结论我们发现，在所有种族/族裔群体中，官方对儿童的虐待与环境贫困之间具有很强的积极联系。我们的数据表明，黑人/白人在官方虐待中的比例失调在很大程度上是由黑人/白人在贫困方面的差异所驱动的。我们的发现还支持官方虐待中存在“西班牙悖论”，与经济上处于同样地位的白人和黑人相比，西班牙裔人的风险更低。