BACKGROUND AND AIMS Caregiver alcohol use is a risk factor for child maltreatment, but a previous meta-analysis was limited to physical abuse only. We aimed to quantify the association of parental or caregiver alcohol use with child maltreatment and assess if this differs by incidence or recurrence of maltreatment and level of caregiver alcohol use.

METHODS We undertook a systematic review and meta-analysis of longitudinal studies according to a registered protocol on PROSPERO (CRD42020211585). We searched the databases MEDLINE, PubMed, Scopus, PsycINFO, CINAHL and the Cochrane Library in November 2024. We included studies that reported the association of interest. We excluded studies that only assessed prenatal alcohol use or caregiver substance use, and studies that did not adjust for socio-economic position. Two reviewers independently screened the retrieved articles for relevance, extracted data from the included studies and assessed the methodological quality of studies using criteria adapted from the Newcastle-Ottawa scale. We performed meta-analyses using inverse variance weighting and random effects models.

RESULTS We included seven studies on child maltreatment incidence and five on recurrence. All were cohort studies in high-income countries: three in Australia, one in Denmark, one in New Zealand, two in South Korea, one in the United Kingdom and four in the United States. The sample size ranged from 501 to 84 245 (median 4782). Caregiver alcohol-related diagnoses were associated with higher child maltreatment incidence [odds ratio (OR) = 2.32, 95% confidence interval (CI) = 1.10-4.89] and recurrence (OR = 1.92, 95% CI = 1.13-3.28) compared with caregivers without alcohol-related diagnoses. An association of any caregiver drinking with child maltreatment incidence could not be ruled out (OR = 1.22, 95% CI = 0.72-2.08). The review was limited by high heterogeneity and variable reporting of alcohol use and child maltreatment; however, we obtained similar results after sensitivity analysis and adjustment for reporting bias.

CONCLUSIONS Caregiver alcohol use may be an important risk factor for child maltreatment, adding to the growing body of evidence on alcohol's harm to others and calling for stronger actions to reduce alcohol harm.