(Reuters Health) – Children in America’s poorest communities have three times the risk of dying from child abuse before age 5 as children in the wealthiest neighborhoods, a new study finds.

“We think our study should inform public health leaders and local clinicians to be aware that children living in high-poverty communities are really a vulnerable group at increased risk of death due to child abuse,” lead author Dr. Caitlin Farrell, a pediatrician at Boston Children’s Hospital, said in a phone interview.

Farrell and her team analyzed death certificates for young children and U.S. Census poverty data from 1999 through 2014. For children ages 4 and under, counties with the highest concentrations of poverty had more than triple the rate of child-abuse fatalities compared to counties with the lowest concentrations of poverty, the study reported in Pediatrics found.

Nearly 10 out of every 100,000 children died as a result of child abuse in the most impoverished counties, the study found.

African-American children were the most vulnerable regardless of where they lived.

Among every 100,000 young children, eight African-Americans died from assault, shaken-baby syndrome, abusive head trauma, suffocation, strangulation or another form of child abuse, compared to three white children, the study found.

The fatality rate for African-American children in the richest counties was higher than the fatality rate for white children in the poorest.

Farrell can’t explain why African-American infants and toddlers were most at risk of dying from abuse. She called for more research and for the development of policies and plans aimed specifically at protecting poor children and African-American children.

During the 15 years covered by the study, 11,149 children died of child abuse before turning 5 years old. Children under the age of 3 comprised the vast majority, or 71 percent, of the deaths, the authors wrote.

African-American children represented a disproportionate 37 percent of the nationwide child-abuse deaths.

“We hope our study can serve as a catalyst for researchers to further explore the complex relationship between community poverty and child abuse,” Farrell said. “Ultimately, this information is needed for policymakers, public health officials and clinicians to enact effective prevention strategies.”

In an accompanying editorial, Dr. Robert Block said the study’s findings should come as no surprise.

“What may be surprising is that although this fact is both intuitive and now statistically proven, given the significant percentage of children living in poverty, the United States has yet to develop a comprehensive plan to address the issue,” he wrote. Block, who was not involved with the study, is a past president of the American Academy of Pediatrics and emeritus professor at the University of Oklahoma – Tulsa University School of Community Medicine in Tulsa.

Poverty-related factors – such as food insecurity, unemployment and living in unsafe neighborhoods with a high prevalence of gun violence – can lead to frustrations and consequent stressors that can lead to child abuse, Block wrote.

Parenting education could help, as could educating community leaders to address the challenges of poverty in an effort to reduce frustration, drug addiction, family violence and other stresses, he wrote.

“To change the influence of poverty and race on the incidence of child-abuse deaths will not be easy,” Block said in an email. “Early identification of troubled parents as part of comprehensive pediatric evaluations might be a beginning.”

Farrell also called for more preventive measures during children’s wellness checks in pediatric clinics.

One limitation of the study is that it could not tease out pockets of poverty within affluent counties or pockets of wealth within poor counties. The study also could not detect possible bias on the part of the medical examiner in determining the cause of death.

SOURCE: bit.ly/2pYx9Bf and bit.ly/2pYLQnL Pediatrics, online April 24, 2017.