An ecologic analysis on the associations between child maltreatment and COVID-19 vaccination, incidence and mortality: A Georgia statewide analysis

Child maltreatment (CM) is a significant public health problem. The COVID-19 pandemic exacerbated risk contexts for families with CM. While preliminary evidence shows increased vaccine hesitancy among parents at high-risk for CM, no studies have explored relationships between CM and actual COVID-19 prevention and health outcomes. This ecologic study aimed to explore county-level associations between CM allegations, with COVID-19 vaccination, infection, and mortality rates during the height of the pandemic from 2020-21. County-level CM allegation rates, collected via intake call data, were obtained from the Division of Family and Children Services (DFCS). County-level 2020-2022 COVID-19 data were obtained from the Georgia Department of Public Health. County-level CM allegation rates were grouped by quartiles. We conducted a negative binomial regression to model associations between CM allegation rates and cumulative COVID-19 vaccination rates, morbidity, and mortality, respectively. When adjusting for county-level % Black, % Female, % rural, high school graduation, median household income, and adjusting mortality and infection rates for vaccination rates, counties in the quartile of highest rates of CM allegations showed a 7% lower vaccination rate (p < 0.003) and nonsignificant increases in infection and mortality rates compared to quartiles with the lowest CM allegations. Findings indicate poor prevention uptake and COVID-19 health outcomes among counties with highest rates of CM allegations. Although limited in causality, these findings suggest the importance of including health promotion strategies in CM prevention and intervention models among at-risk households. • To date, no research has studied associations between CM and COVID-19 outcomes. • Results may indicate that CM is associated with lower COVID-19 vaccination rates. • At-risk families are an overlooked population needing supportive health prevention efforts.