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Do socioeconomic and birth order gradients in child maltreatment differ by immigrant status?
  1. Kathleen S Kenny1,
  2. Ariel Pulver2,
  3. Patricia O’Campo2,3,
  4. Astrid Guttmann4,5,6,7,
  5. Marcelo L Urquia1,6
  1. 1 Department of Community Health Sciences, Max Rady College of Medicinea, University of Manitoba, Winnipeg, Canada
  2. 2 Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
  3. 3 Li Ka Shing Knowledge Institute, St.Michael’s Hospital, Toronto, Canada
  4. 4 Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada
  5. 5 Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
  6. 6 Institute for Clinical Evaluative Sciences, Toronto, Canada
  7. 7 Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
  1. Correspondence to Kathleen S Kenny, Community Health Sciences, Max Rady College of Medicine, University of Manitoba Manitoba Centre for Health Policy, Winnipeg R3E 3P5, Canada; kathleen_kenny{at}


Background While literature has documented strong gradients in child maltreatment (CM) by socioeconomic status and family composition in the general population, how these patterns extend to immigrants remain inconclusive. Using population-based administrative data, we examined, for the first time, whether gradients in CM by neighbourhood income and childbirth order vary by immigrant status.

Methods We used linked hospitalisation, emergency department visits, small-area income, birth and death records with an official Canadian immigration database to create a retrospective cohort of all 1 240 874 children born from 2002 to 2012 in Ontario, Canada, followed from 0 to 5 years. We estimated rate ratios of CM among immigrants and non-immigrants using modified Poisson regression.

Results CM rates were 1.6 per 100 children among non-immigrants and 1.0 among immigrants. CM was positively associated with neighbourhood deprivation. The adjusted rate ratio (ARR) of CM in the lowest neighbourhood income quintile versus the highest quintile was 1.57 (95% CI 1.49 to 1.66) for non-immigrants and 1.33 (95% CI 1.15 to 1.54) for immigrants. The socioeconomic gradient disappeared when restricted to children of immigrant mothers arrived at 25+ years and in analyses excluding emergency department visits. Compared to a first child, the ARR of CM for a fourth or higher-order child was 1.75 (95% CI 1.63 to 1.89) among non-immigrants and 0.57 (95% CI 0.44 to 0.74) among immigrants.

Conclusions Immigrants exhibited lower CM rates than non-immigrants across neighbourhood income quintiles and differences were greatest in more deprived neighbourhoods. The contrasting birth order gradients between immigrants and non-immigrants require further investigation.

  • Socio-economic
  • child health
  • migration
  • neighbourhood/place

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  • Contributors KSK, AP and MLU conceived the study and developed the analytic strategy. AG and POC contributed to study design. AP, MLU and KSK analysed the data. KSK led the writing of the manuscript. All authors made significant contributions to the interpretation of the data, drafting of the article and approved the final version of the manuscript.

  • Funding KSK is supported by MLU’s CIHR Foundation Grant (CIHR FDN-154280). MLU is supported by a Canadian Research Chair in Applied Population Health. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the authors and not necessarily those of CIHI.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data used for the current study are held securely at ICES in Ontario, Canada. Data sharing agreements prohibit ICES from making the dataset publicly available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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