Articles www.thelancet.com Published online July 12, 2012 http://dx.doi.org/10.1016/S0140-6736(12)60692-8 1 Prevalence and risk of violence against children with disabilities: a systematic review and meta-analysis of observational studies Lisa Jones, Mark A Bellis, Sara Wood, Karen Hughes, Ellie McCoy, Lindsay Eckley, Geoff Bates, Christopher Mikton, Tom Shakespeare, Alana Officer Summary Background Globally, at least 93 million children have moderate or severe disability. Children with disabilities are thought to have a substantially greater risk of being victims of violence than are their non-disabled peers. Establishment of reliable estimates of the scale of the problem is an essential first step in the development of effective prevention programmes. We therefore undertook a systematic review and meta-analysis to synthesise evidence for the prevalence and risk of violence against children with disabilities. Methods For this systematic review and meta-analysis, we searched 12 electronic databases to identify cross-sectional, case-control, or cohort studies reported between Jan 1, 1990, and Aug 17, 2010, with estimates of prevalence of violence against children (aged ≤18 years) with disabilities or their risk of being victims of violence compared with children without disabilities. Findings 17 studies were selected from 10 663 references. Reports of 16 studies provided data suitable for meta-analysis of prevalence and 11 for risk. Pooled prevalence estimates were 26·7% (95% CI 13·8–42·1) for combined violence measures, 20·4% (13·4–28·5) for physical violence, and 13·7% (9·2–18·9) for sexual violence. Odds ratios for pooled risk estimates were 3·68 (2·56–5·29) for combined violence measures, 3·56 (2·80–4·52) for physical violence, and 2·88 (2·24–3·69) for sexual violence. Huge heterogeneity was identified across most estimates (I²>75%). Variations were not consistently explained with meta-regression analysis of the characteristics of the studies. Interpretation The results of this systematic review confirm that children with disabilities are more likely to be victims of violence than are their peers who are not disabled. However, the continued scarcity of robust evidence, due to a lack of well designed research studies, poor standards of measurement of disability and violence, and insufficient assessment of whether violence precedes the development of disability, leaves gaps in knowledge that need to be addressed. Funding WHO Department of Violence and Injury Prevention and Disability. Introduction Violence against children is a huge and serious problem worldwide. 1 An estimated 53 000 children aged 0–17 years were murdered in 2002 and about 150 million girls and 73 million boys were thought to have been sexually abused. 1 However, little is known about the magnitude of violence against children with disabilities. Worldwide, an estimated 5% of children (about 93 million) aged 0–14 years have moderate or severe disability, with estimates ranging from 2·9% in high-income countries to 4·4–6·4% in low-income and middle-income countries. 2 The results of a review 3 of the extent of violence in adults with disabilities showed that they are at increased risk of being victims of violence compared with those without disabilities; adults with mental illness are particularly vulnerable. Children with disabilities are also thought to be at greater risk of violence than are those without. The reasons for this difference include societal stigma and discrimination, negative traditional beliefs and ignorance within communities, 4 lack of social support for carers, 5 type of impairment (eg, commu- nication difficulties), and heightened vulnerability as a result of the need for increased care, including medical attention. 6 Reliable estimates of the extent of the problem are essential for the development of effective population- level public health programmes to prevent children with disabilities from becoming victims of violence, and improve their health and quality of life. The conclusion drawn from the findings of a previous systematic review of population-based studies was that the association between childhood disability and abuse was weak. 7 However, this study was not based on a quantitative synthesis of the evidence and the results of individual studies continue to draw attention to the increased risk of becoming a victim of violence for a child with a disability. 8 We undertook a systematic review and meta-analysis to identify the characteristics and coverage of research into the prevalence and risk of violence perpetrated against children (aged ≤18 years) with disabilities; assess the quality of this research; and undertake a quantitative synthesis of the evidence, with a view to identifying knowledge gaps and research priorities. Published Online July 12, 2012 http://dx.doi.org/10.1016/ S0140-6736(12)60692-8 See Online/Comment http://dx.doi.org/10.1016/ S0140-6736(12)61071-X Centre for Public Health, Liverpool John Moores University, Liverpool, UK (L Jones BSc, Prof M A Bellis DSc, S Wood MSc, K Hughes PhD, E McCoy MSc, L Eckley PhD, G Bates MSc); and WHO Department of Violence and Injury Prevention and Disability, Geneva, Switzerland (C Mikton PhD, T Shakespeare PhD, A Officer MPH) Correspondence to: Prof Mark A Bellis, Centre for Public Health, Liverpool John Moores University, Liverpool L3 2ET, UK m.a.bellis@ljmu.ac.uk