A "drastic" increase in drownings and fatalities due to neglect contributed to an overall increase in child deaths in Arizona last year, a new state report says.
The rate of Arizona children ages newborn through 17 who died in 2021 reached its highest level in 10 years, the Arizona Child Fatality Review Program's 29th annual report says. Arizona’s child mortality rate increased by 4.7% from 51 deaths per 100,000 children in 2020 to 53.4 deaths per 100,000 children in 2021.
"It is a significant increase. We like to look at trends for what is happening, and hopefully this isn't a trend," said pediatrician Dr. Mary Ellen Rimsza, chair of the Arizona Child Fatality State Team.
A total of 863 children died in Arizona last year, up from 838 the prior year. Nearly half of last year's deaths were preventable, according to authors of the report, who base their analysis on reviews of death certificates, autopsy reports, hospital records, law enforcement reports, and any other relevant documents that provide insight into the cause of a child's death.
Arizona child death rates from drowning and abuse or neglect "increased drastically" from 2020, says the report, which was released earlier this month. Child drownings doubled from 22 deaths in 2020 to 44 deaths in 2021, and drowning was the most common cause of death in children ages one through four years old, the report says.
"We were very surprised to see how many drownings we had. It's been going down in that category for many years and now it went back up again. That was very concerning," Rimsza said. "It's very tragic how it can happen so quickly in situations where people have a backyard pool."
There were 128 Arizona children who died from abuse or neglect in 2021, up from 95 such deaths in 2020. The mortality rate of Arizona children due to abuse or neglect rose by 36.2% from 5.8 deaths per 100,000 children in 2020 to 7.9 deaths per 100,000 children in 2021, which is the highest rate in the past 10 years.
"The majority of those are not abuse. They are neglect. And so I think we need to consider, what are the situations where neglect occurs," Rimsza said. "Some of it isn't intentional neglect, it's neglect through a lack of money for a place to live, for childcare, so they have unsafe childcare situations ... A great deal has to do with poverty."
Rimsza noted that substance use played a role in more than half of the child deaths from abuse or neglect in 2021, a factor that in some cases may have been related to COVID-19. Numerous reports and studies have indicated that use of drugs and alcohol increased during the pandemic due to, among other things, stress and isolation.
The Child Fatality Review Program investigates and reports on the death of all children who die in Arizona regardless of state residency.
The leading causes of death for children in Arizona last year were (in order):
Congenital abnormality: 108
Motor Vehicle Crash: 72
Firearm Injury: 56
Black and Native American children died at disproportionate rates
As in prior years, Black and Native American or Alaska Native children died at rates disproportionate to their population size in 2021. For example, the infant mortality rate for Black infants was 14 per 1,000 live births in 2021, while for white infants the rate was four per 1,000 live births. Black infants made up 16% of infant deaths in Arizona last year but comprised only 6% of live births.
Children of Native American or Alaska Native backgrounds comprised 11% of the child deaths statewide last year yet represent only 5% of the total child population. Of the 44 child suicides in Arizona last year, 18% were Native American or Alaska Natives, the report says. Such children were also disproportionately represented in deaths by motor vehicle crashes, the report found. Nearly one-quarter of the 72 children statewide who died as a result of motor vehicle crashes last year were Native American or Alaska Native, the report's data shows.
Authors of the report recommended taking action at the state level to prevent those racial inequities from continuing.
"American Indian and Black children are disproportionately affected by mortality at greater levels than White and Hispanic children despite both groups representing small proportions of the total Arizona population," the report says. "Further investigation of these disparities can lead to evidence-based tailored public health programs and interventions to improve mortality rates for Arizona's American Indian and Black communities."
Disparities in child mortality rates for Black and Native American or Alaska Native children have been persistent throughout the nearly 30 years of Arizona child fatality reports.
"You can't just say it's from poverty because we have poor white kids and poor Hispanic kids, although that may be a factor," Rimsza said. "They (Black and Native people) may be less comfortable or have less access to health care systems or utilizing the health care systems. We really need to be directing more services to that population."
Rimsza said state and county health departments need to investigate ways to eliminate racial disparities in child deaths, and will require adequate funding to do it. And in order to effect change, the governor and the Arizona Legislature will have to pay attention to any recommendations that come out of such research, Rimsza said.
Suffocation was the leading cause of child deaths due to neglect
Suffocation was the leading cause of deaths due to neglect, according to the report. Although it did not detail the specifics of each of the 23 such deaths in 2021, lack of safe sleeping practices has been a longstanding issue.
Health care clinics, such as Mountain Park Health Center in south Phoenix, have given expectant parents safe sleep kits that promote having babies sleep on their backs in cribs that are free of cushiony materials, such as stuffed animals. Experts also advise against having the baby sleep in a parent’s bed, where they could be accidentally crushed by an adult rolling over.
Motor vehicle crashes and complications from a premature birth are close seconds on the leading cause of deaths due to neglect or abuse, with 22 in each category, the report states.
As Rimsza noted, the two biggest risk factors associated with these deaths are substance abuse and poverty, issues that are often intertwined.
Prevent Child Abuse Arizona, a nonprofit focused on protecting children and strengthening family bonds, offers numerous tips to help families. It also hosts a program called Shift that seeks to reduce the stigma associated with a parent’s substance abuse. It works with substance abuse professionals and family support organizations to quickly identify babies who have been born substance-exposed and to get services to their parents.
Child abuse and neglect deaths due to stabbing or strangulation were not quantified, other than to note there were fewer than six such incidents in 2021. Because the number was so small, the report left out a precise figure in order to protect the identity of the child victims.
Nine of the 128 child abuse and neglect deaths in 2021 were due to firearms, the report found.
A total of 56 Arizona children died due to firearms in 2021 − 7% of all child deaths in the state − and the report's authors determined that all of them were preventable. Of those firearm deaths, 79% of the children were male, 21% were female. Firearm injury was the leading cause of death among children ages 15 to 17 years old, and Arizona's childhood mortality rate due to firearms was at its highest level in a decade last year.
Firearms were used in more than half of the 47 homicides that killed children in Arizona last year and in 38% of the 44 suicides, the report says.
The report recommends increasing public awareness in Arizona that the most effective way to prevent firearm-related deaths in children and adolescents is to remove firearms from homes.
Arizona's child COVID-19 mortality rate in 2021 was more than twice the U.S. rate
For a second year in a row, the childhood fatality report included a section on COVID-19 deaths. The latest report found Arizona's childhood mortality rate due to COVID-19, at 1.92 deaths per 100,000 children ages newborn through 17, was more than twice the U.S. average of 0.83 deaths per 100,000 children.
The numbers are small, as COVID-19 has a more severe effect on older people. But the report shows that children are not immune to the effects of COVID-19. The report says 31 children in Arizona died as a direct result of COVID-19 and a majority were children ages birth through 11 years old, who were too young to receive the COVID-19 vaccination for much of 2021. Babies and young children under the age of five were not eligible for the COVID-19 vaccine until this year.
"It's concerning because we didn't follow public health and CDC recommendations for how to prevent children from acquiring COVID-19 and I think this is a reflection of that, that our rates are higher," Rimsza said. "There were a whole variety of things that could have been done in our school system when they were open ... There were a whole number of things that could have been done as a state that weren't done."
The COVID-19 death toll last year included 11 children in Arizona with multisystem inflammatory syndrome in children (MIS-C), which is a rare but serious condition associated with COVID-19 where different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs.
"While there are numerous preventable risk factors that contribute to direct COVID-19 deaths,poverty (61%) was the most commonly identified risk factor," the report says.
People who live in poverty find it more difficult to get medical care for many reasons including a lack of transportation, and they are also more likely to be living in crowded situations where there's more risk of a virus coming into the home.
"I think one of the biggest ones is the fact that poor people were working throughout the pandemic. They didn't have the benefit of leaving their minimum-wage job to be at home or work from home," Rimsza said. "They don't have the kind of jobs where you work at home. They are working in the service sector, cleaning buildings and serving food and that sort of thing."
The report also found "strong evidence" that COVID-19 indirectly contributed to 27 child deaths in 2021. Those indirect deaths include incidences where children died in situations that might have been prevented were it not for the COVID-19 pandemic such as deaths that occurred during school closures when the child may not have died if they were physically in school and deaths where COVID-19 impacted the availability and fear of seeking medical care.
This article originally appeared on Arizona Republic: State report finds a "drastic" rise in AZ child deaths due to drowning