International studies provide evidence of an association between child disabilities, including hearing impairment (HI), and child maltreatment. There are high prevalences of ear disease with associated HI, and child maltreatment among Australian Aboriginal children, but the link between HI and child maltreatment is unknown. This study investigates the association between HI and child maltreatment for Aboriginal children living in the Northern Territory (NT) of Australia. This was a retrospective cohort study of 3895 Aboriginal school-aged children (born between 1999 and 2008) living in remote NT communities. The study used linked individual-level information from health, education and child protection services. The outcome variables were child maltreatment notifications and substantiations. The key explanatory variable, HI, was based on audiometric assessment. The Kaplan–Meier estimator method was used in univariate analysis; Cox proportional hazards regression was used in multivariable analysis. A majority of the study cohort lived in very remote (94.5%) and most disadvantaged (93.1%) regions. Among all children in the study cohort, 56.1% had a record of either HI or unilateral hearing loss (UHL), and for those with a history of contact with child protection services (n = 2757), 56.7% had a record of HI/UHL (n = 1564). In the 1999–2003 birth cohort, by age 12 years, 53.5% of children with a record of moderate or worse HI had at least one maltreatment notification, compared to 47.3% of children with normal hearing. In the 2004–2008 cohort, the corresponding results were 83.4 and 71.7% respectively. In multivariable analysis, using the full cohort, children with moderate or worse HI had higher risk of any child maltreatment notification (adjusted Hazard Ratios (adjHR): 1.16, 95% CI:1.04–1.30), notification for neglect (adjHR:1.17, 95% CI:1.04–1.31) and substantiation (adjHR:1.20, 95% CI:1.04–1.40), than children with normal hearing. In the 2004–2008 birth cohort, children with moderate or worse HI had higher risk of a substantiated episode of physical abuse (adjHR:1.47, 95% CI:1.07–2.03) than children with normal hearing. Our findings demonstrate the urgent need for HI and child maltreatment prevention strategies through raised community awareness and inter-agency collaboration. Effective information-sharing between service providers is a critical first step to a public health approach in child protection.

中文翻译：

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澳大利亚北领地土著儿童中听力障碍与虐待儿童之间的联系：在儿童保护方面采取公共卫生措施是否有机会？

国际研究提供了包括听力障碍（HI）在内的儿童残疾与虐待儿童之间的关联的证据。在澳大利亚原住民儿童中，与HI相关的耳部疾病和儿童虐待的患病率很高，但HI与儿童虐待之间的联系尚不清楚。本研究调查了居住在澳大利亚北领地（NT）的原住民儿童的HI与虐待儿童之间的关系。这是一项对居住在北领地偏远社区的3895名学龄儿童（1999年至2008年出生）进行的回顾性队列研究。该研究使用了来自健康，教育和儿童保护服务的个人信息链接。结果变量是虐待儿童的通知和证据。关键说明变量HI 基于听觉评估。Kaplan–Meier估计器方法用于单变量分析；Cox比例风险回归用于多变量分析。大多数研究人群居住在非常偏远的地区（94.5％）和最弱势的地区（93.1％）。在该研究队列的所有儿童中，有56.1％的人有HI或单侧听力下降（UHL）的记录，而有接触儿童保护服务史的儿童（n = 2757），有56.7％的人有HI / UHL（n = 1564）。在1999年至2003年的出生队列中，按12岁的年龄，有HI记录为中度或重度的儿童中有53.5％至少有一次虐待的通知，而听力正常的儿童中这一比例为47.3％。在2004-2008年队列中，相应的结果分别为83.4和71.7％。在多变量分析中，使用整个队列 中度或重度HI患儿有任何儿童虐待通知的风险较高（调整后的危险比（adjHR）：1.16，95％CI：1.04-1.30），被忽视的通知（adjHR：1.17，95％CI：1.04-1.31）证实（adjHR：1.20，95％CI：1.04-1.40），比听力正常的儿童高。在2004-2008年的出生队列中，重度中度或重度HI患儿比有听力正常的患儿遭受确凿的身体虐待风险更高（adjHR：1.47，95％CI：1.07-2.03）。我们的发现表明，通过提高社区意识和机构间合作，迫切需要预防HI和儿童虐待策略。服务提供商之间有效的信息共享是保护儿童的公共卫生方法的关键的第一步。