Global estimates of violence against children with disabilities: an updated systematic review and meta-analysis

Background Previous meta-analysis evidence shows that children (aged 0-18 years) with disabilities experience high amounts of violence. During the past decade, there has been a substantial increase in the volume of available data, and we therefore aimed to update the evidence and provide a current global estimate of violence against children with disabilities. Methods For this systematic review and meta-analysis, we searched 18 English-language international databases for observational studies published in English or Chinese between Aug 17, 2010, and Sept 16, 2020, and three Chinese databases for studies published from database inception to Sept 16, 2020. We used search terms structured around the concepts of disability, child, and violence-defining violence as physical, emotional, or sexual violence, or neglect, and considering disability as physical, mental, intellectual, and sensory impairments, and chronic diseases. We also searched 11 grey-literature repositories and hand searched the reference lists of included records for observational studies. We double screened records for studies that measured violence against children with disabilities. We excluded studies that included only people who had experienced violence or that did not provide separate estimates for children if adults were also included. Two authors independently extracted data and appraised study quality. We pooled estimates using three-level, mixed-effects meta-analyses, and did subgroup analyses. This study was prospectively registered with PROSPERO, CRD42020204859. Findings We found and screened 26 204 records, of which we excluded 25 844. We assessed 386 full text articles and finally included 98 studies (with 16 831 324 children) in our analysis. Our results showed that the overall prevalence of violence against children with disabilities was 31.7% (95% CI 27.1-36.8; I-2=99.15%; 16 807 154 children, 92 studies) and the overall odds ratio of children with versus without disabilities experiencing violence was 2.08 (1.81-2.38; I-2=91.5%; 16 811 074 children, 60 studies). Sensitivity analyses suggested a high degree of certainty for these estimates, although there was a high degree of heterogeneity across most estimates. There was some risk of publication bias, although the included studies were, on average, of medium quality. The estimates of violence differed by the type of violence, disability, and perpetrator. Children in economically disadvantaged contexts were especially vulnerable to experiencing violence. Interpretation This review shows that children with disabilities experience a high burden of all forms of violence, despite advances in awareness and policy in the past 10 years. Our results indicate a need for increased partnerships across disciplines and sectors to protect children with disabilities from violence. Additional well designed research is also needed, especially in under-represented and economically disadvantaged populations. Copyright (C) 2022 Elsevier Ltd. All rights reserved.