In the United States (U.S.), child abuse and neglect (CAN) is a significant public health problem (Leeb, Paulozzi, Melanson, Simon, & Arias, 2008). National CAN data indicates roughly 558,899 children were reported and confirmed to have experienced CAN in 2022; an estimated 1990 died from CAN (U.S. Department of Health & Human Services [USDHHS], The Administration for Children and Families [ACF], 2024a). Black or African American (Black), non-Hispanic (NH) children have the highest CAN fatality rate (6.4 per 100,000 children) in the U.S., followed by children of two or more races (multiracial; 4.0 per 100,000 children), American Indian or Alaska Native (AI/AN), NH children (3.4 per 100,000 children), White, NH children (2.0 per 100, 000 children), and Hispanic or Latino children (Hispanic; 1.7 per 100, 000 children) (USDHHS, ACF, 2024a).

Although fatal CAN involves a set of behaviors (e.g., physical assault, neglect) by a parent or caregiver (Leeb et al., 2008), research shows that a complex interplay between factors can either protect against or increase risk of CAN perpetration and victimization (Drake, Jonson-Reid, & Dvalishvili, 2022; Maguire-Jack & Font, 2017; USDHHS, ACF, 2023/2024). Risk factors exist at various levels such as the individual-(parent or caregiver [e.g., maternal depression]), family-, or community-level (e.g., poverty); children exposed to a multitude of these factors are at an increased risk of experiencing CAN (Drake et al., 2022; Dubowitz et al., 2011; Maguire-Jack & Font, 2017).

Community poverty is a well-documented factor associated with fatal and nonfatal CAN (Drake et al., 2022; Farrell et al., 2017; Kim & Drake, 2023; Maguire-Jack & Font, 2017). Studies show families residing in communities with high poverty levels often experience heightened stress and material hardships (e.g., inadequate resources for housing) (Drake et al., 2022; Pelton, 1994), creating conditions that make it harder for parents and caregivers to nurture and protect their children (USDHHS, ACF, 2023/2024). Understanding the intersection of fatal CAN and community poverty is important for prevention. The purpose of this study is to examine racial and ethnic differences in fatal CAN among U.S. children and how community poverty intersects with these deaths.

In this study, during 2003–2022, more than one in three fatal CAN victims resided in communities classified as the most impoverished, disproportionately AI/AN and Black victims. Research shows nonfatal and fatal CAN among children is not independent of broader social and structural factors (e.g., poverty) that impact parenting (Drake et al., 2022; Kim & Drake, 2023; Maguire-Jack & Font, 2017; USDHHS, ACF, 2023/2024), serving as mechanisms through which CAN has been found to occur (Chandler, Austin, & Shanahan, 2022; Drake et al., 2022; USDHHS, ACF, 2023/2024). The inequities of residing in communities with the highest poverty level persisted over the entire study period for both AI/AN and Black children, a finding consistent with national child poverty data that show AI/AN, Black, and Hispanic children face far greater exposure to poverty than API and White children (Annie E. Casey Foundation, 2024). In 2022, Black children accounted for the highest proportion of children living in poverty, followed by AI/AN (Annie E. Casey Foundation, 2024), reflective of a history of systemic racism with longstanding and ongoing effects on policies and practices that disadvantage families of color (Williams & Collins, 2001). Economic inequities exacerbate broader patterns of community poverty and negative outcomes associated with concentrated disadvantage (Kneebone & Holmes, 2016; Williams & Collins, 2001), challenging the foundation of strong families and communities (USDHHS, ACF, 2023/2024).

Community poverty, which reflects concentrated disadvantage (e.g., elevated levels of community violence, material hardship, and neighborhood divestment) (Molnar, Buka, Brennan, Holton, & Earls, 2003; U. S. Department of Agriculture, Economic Research Service, 2023), creates pathways through which CAN has been found to occur (Drake et al., 2022; Kim & Drake, 2023; Maguire-Jack & Font, 2017; Molnar et al., 2003). Studies show policies that strengthen economic supports for families often yield significant benefits for children, their families, and communities (Austin et al., 2023; Kovski et al., 2022), underscoring the importance of supporting parents and caregivers by employing antipoverty policies (Kim & Drake, 2019), investing in communities to improve childhood outcomes, and providing equitable access to economic supports and well-resourced communities (Jutte, Badruzzaman, & Thomas-Squance, 2021). In the present study, the largest proportion of fatal CAN victims were aged 1–5 years; a larger proportion of AI/AN and Black children were in this age group; two racial groups that had roughly one in two fatal CAN victims residing in communities with the highest poverty level. Children aged 1–5 years are likely not yet attending grade school, and parents and caregivers living in poverty are least likely to be able to afford quality childcare, highlighting the importance of providing families with access to resources (e.g., early childhood education and high-quality and affordable child care) that have been found to mitigate risk of CAN (Ha, Collins, & Martino, 2015; Johnson-Staub, 2017; Klein, 2011). Prior research found that communities characterized by concentrated poverty and inadequate resources for childcare experienced higher rates of CAN referrals and substantiations, whereas communities with more wealth experienced lower rates (Ha et al., 2015), suggesting that access to childcare services and resources at the community-level are important points of CAN prevention for families with young children and who are residing in communities with high levels of poverty. Providing eligible (e.g., income-driven) families with access to early childhood education (e.g., Early Head Start) has been linked to a wide range of positive child, parent, and family outcomes such as reduced child aggression, parental stress, and parental use of physical punishment (Vogel, Brooks-Gunn, Martin, & Klute, 2013), factors cited as contributors to CAN (Fortson, Klevens, Merrick, Gilbert, & Alexander, 2016; Wilson et al., 2023a). Racial inequities in access to early childhood education and childcare resources exist (Johnson-Staub, 2017), and only 11% of eligible children have access to Early Head Start (National Head Start Association [NHSA], 2024), leaving countless children and families without access to resources that protect against CAN (Johnson-Staub, 2017; NHSA, 2024).

Multiple factors can contribute to risk of fatal CAN victimization (Kennedy, Lazoritz, & Palusci, 2020; Vogel et al., 2013), and the pattern of injuries inflicted upon child victims can take on many forms (Wilson et al., 2023b). As seen in other studies (Wilson et al., 2023b), in the current analysis, the largest proportion of homicides of CAN victims were killed by the perpetrator’s use of personal weapons (i.e., hands, fists, feet), followed by blunt instruments, and firearms. Prior studies suggest the variability in methods by which a perpetrator uses to kill a child in fatal CAN is influenced by factors such as the relationship of the perpetrator to the victim and circumstances or contextual factors (e.g., IPV) surrounding the incident (Daly & Wilson, 1994; Debowska, Boduszek, & Dhingra, 2015; U.S. Department of Health & Human Services, 2024a). Fathers accounted for the largest single category of perpetrators of fatal CAN in the current study. API, multiracial, and White children were significantly more likely to be killed by their fathers than Black children killed by theirs, whereas Black children were significantly more likely to be killed by their mothers than White children being killed by theirs. Research suggests that the characteristics of child homicides committed by mothers are different from those committed by fathers and other male perpetrators (Flynn, Shaw, & Abel, 2013; Porter & Gavin, 2010; Resnick, 1969; Wilson et al., 2023c). As such, studies report mental illness, removal of an unwanted child, CAN, or perceived altruism as some common precipitators in maternal homicides (Debowska et al., 2015; Porter & Gavin, 2010; Resnick, 1969), whereas child homicides committed by fathers often involve IPV, relationship conflict, firearms, and frequently co-occur with perpetrator’s suicide (Debowska et al., 2015; Flynn et al., 2013; Logan, Walsh, Patel, & Hall, 2013; Wilson et al., 2023c). Further findings from prior studies show that almost two-thirds of perpetrators in homicide–suicide incidents with child victims were experiencing intimate partner problems before killing the child (Logan et al., 2013). In the present analysis, larger proportions of API, Hispanic, and White fatal CAN involved IPV, family relationship problems, and involved the use of firearms than Black victims. Taken together, this might help explain why larger proportions of these children were killed by their fathers than Black children killed by theirs. In the present analysis, lower percentages of API (12.4%), Hispanic (31.3%), and White (28.7%) fatal CAN victims resided in communities with higher levels of poverty than Black children (46.7%), which might suggest, for families not experiencing poverty, a convergence of other stressors such as family and intimate partner conflict might be more common in fatal CAN among API, Hispanic, and White children. Teaching safe and healthy relationship skills and conflict resolution across the lifespan, screening for child safety issues among parents at an outpatient pediatric clinic, including exposure to IPV, and supporting IPV survivors to increase safety and lessen harms, have all been proposed as strategies to reduce IPV across the lifespan, including those that involve child victims (Niolon et al., 2017; Thackeray, Hibbard, Dowd, & Committee on Child Abuse and Neglect; Committee on Injury, Violence, and Poison Prevention, 2010).

Further, prior research has documented perpetrator mental illness as a correlate of fatal CAN (Flynn et al., 2013, 2016). Findings from the present study indicate at least 5.6% of the attacks on fatal CAN victims were believed to be the direct result of the perpetrator’s mental illness. Mental illness and crisis episodes often co-occur, especially among suicide decedents (National Alliance on Mental Illness [NAMI], 2024). We found larger proportions of API and White fatal CAN were related to perpetrator’s mental illness or co-occurred with perpetrator’s suicide than Black victims; nearly one in two API fatal CAN victims resided in communities classified as the least impoverished; 17.3% of White and one out of ten Black fatal CAN victims resided in these communities. One study found almost 2 out of 3 of the perpetrators (predominately White males) who committed homicide of a spouse and/or their children before dying by suicide had mental health problems; most of these incidents were precipitated by relationship dissolution (Flynn, Shaw, & Abel, 2007). Prior studies show that not all perpetrators of fatal CAN are receiving mental health treatment at the time of the fatal event (Flynn et al., 2007). In one study that examined 112 perpetrators convicted of infanticide in England and Wales found that 24% had symptoms of mental illness at the time of the offense, 34% had a lifetime history of mental illness, and 14% had been treated for their mental illness (Flynn et al., 2007), highlighting the fact that some perpetrators of fatal CAN may not come to the attention of mental health providers prior to the fatal event. Others (e.g., API communities) might experience barriers (e. g., language barriers, racism, stigma [cultural and societal]) to mental health care (NAMI, 2023). Connecting families who are facing mental health problems or are in crisis and who might not be receiving mental health treatment with emotional and behavioral health supports might aid in preventing fatal and nonfatal CAN.

Findings from this study are subject to a few limitations. First, NVDRS data abstractors are limited to information included in investigative reports, which might not include all characteristics and circumstances for all decedents. Second, due to small counts for AI/AN, API, and multiracial fatal CAN victims, data could not be reported for all years for these groups. Third, this study examined county-level poverty and not children living in poverty; there may have been instances where child victim’s community or household socioeconomic status was different from county-level poverty. Future research might consider a similar analysis using Census Tract-level data to provide a more proximal account of victims’ community-level economic characteristics. Finally, states/jurisdictions joined NVDRS during different years; thus, data were not available for all states/jurisdictions for all data years. Despite these limitations, findings from this study add to the existing literature on the intersection of community poverty and fatal CAN among different racial and ethnic groups.

In this study, we found the racial and ethnic differences in fatal CAN varied across multiple characteristics and circumstances. Our findings highlight the importance of a comprehensive approach to preventing CAN, such as providing families access to parent training, early education, high-quality and affordable childcare, mental health care, and economic supports, and creating safe, stable, and nurturing relationships and environments for all children (Fortson et al., 2016; Jutte et al., 2021). Further, consistent with other studies, we found that IPV threatens the safety and well-being of children, highlighting the importance of assessing risk of lethal danger of both adult victims and their children in IPV situations (Wilson et al., 2023c).

Additionally, we found racial and ethnic inequities in fatal CAN victims residing in counties classified as the most and least impoverished. Decades of research has documented an association between community poverty and CAN (Coulton, Korbin, Su, & Chow, 1995; Drake et al., 2022; Farrell et al., 2017; Maguire-Jack & Font, 2017). CAN prevention efforts have historically focused on changing individual parent or caregiver behavior, and to a lesser degree, focused on social and structural inequities (e.g., poverty) that amplify families of colors’ need for social services (Child Welfare Information Gateway, 2021; Child Welfare Information Gateway, 2023; USDHHS, ACF, 2023/2024). The complex nature of CAN suggests that to prevent CAN, an approach that extends beyond the child welfare system and includes antipoverty policies and programs, antiracism actions, and a broader range of family-serving systems, resources, and supports (e.g., food, housing, economic supports, mental healthcare services, childcare, etc.) for families facing challenges (e.g., mental health problems) and challenging conditions (e.g., poverty) are important to reduce risk for fatal CAN and racial and ethnic inequities in risk (Child Welfare Information Gateway, 2023; Jones, 2021; USDHHS, ACF, 2023/2024). Fatal and nonfatal CAN are preventable. Employing multiple strategies, at various levels (e.g., individual, familial, community), might aid in preventing nonfatal and fatal CAN.

Supplementary data to this article can be found online at https://doi.org/10.1016/j.chipro.2025.100108.