Surveillance for Violent Deaths — National Violent Death Reporting System, 17 States, 2013

Surveillance Summaries / August 19, 2016 / 65(10);1–42

Bridget H. Lyons, MPH1; Katherine A. Fowler, PhD1; Shane P.D. Jack, PhD1; Carter J. Betz, MS1; Janet M. Blair, PhD1 (View author affiliations)

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Abstract

Problem/Condition: In 2013, more than 57,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) regarding violent deaths from 17 U.S. states for 2013. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics.

Reporting Period Covered: 2013.

Description of System: NVDRS collects data from participating states regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 17 states that collected statewide data for 2013 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, North Carolina, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) from a single incident.

Results: For 2013, a total of 18,765 fatal incidents involving 19,251 deaths were captured by NVDRS in the 17 states included in this report. The majority (66.2%) of deaths were suicides, followed by homicides (23.2%), deaths of undetermined intent (8.8%), deaths involving legal intervention (1.2%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (<1%). (The term legal intervention is a classification incorporated into the International Classification of Diseases, Tenth Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Suicides occurred at higher rates among males, non-Hispanic whites, American Indian/Alaska Natives, persons aged 45–64 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, or physical health problem or a crisis during the previous or upcoming 2 weeks. Homicide rates were higher among males and persons aged 15–44 years; rates were highest among non-Hispanic black males. Homicides primarily were precipitated by arguments and interpersonal conflicts, occurrence in conjunction with another crime, or were related to intimate partner violence (particularly for females). A known relationship between a homicide victim and a suspected perpetrator was most likely either that of an acquaintance or friend or an intimate partner. Legal intervention death rates were highest among males and persons aged 20–24 years and 30–34 years; rates were highest among non-Hispanic black males. Precipitating factors for the majority of legal intervention deaths were another crime, a mental health problem, or a recent crisis. Deaths of undetermined intent occurred at the highest rates among males and persons aged <1 year and 45–54 years. Substance abuse and mental or physical health problems were the most common circumstances preceding deaths of undetermined intent. Unintentional firearm death rates were higher among males, non-Hispanic whites, and persons aged persons aged 15–19 and 55–64 years; these deaths were most often precipitated by a person unintentionally pulling the trigger while playing with a firearm or while hunting.

Interpretation: This report provides a detailed summary of data from NVDRS for 2013. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected persons aged <65 years, males, and certain minority populations. For homicides and suicides, intimate partner problems, interpersonal conflicts, mental health problems, and recent crises were primary precipitating factors.

Public Health Action: NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths. For example, Utah Violent Death Reporting System (VDRS) data were used to develop policies that support children of intimate partner homicide victims, Colorado VDRS data to develop a web-based suicide prevention program targeting middle-aged men, and Rhode Island VDRS data to help guide suicide prevention efforts at workplaces. The continued development and expansion of NVDRS to include all U.S. states, territories, and the District of Columbia are essential to public health efforts to reduce the impact of violence.

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Introduction

In 2013, more than 57,000 persons died in the United States as a result of violence-related injuries (1). Suicide was the 10th leading cause of death overall in the United States and disproportionately affected young and middle-aged populations. It was among the top three leading causes of death for persons aged 10–34 years and among the top five for persons aged 35–54 years. American Indian/Alaska Natives were disproportionately affected by suicide; it was the second leading cause of death among those aged 10–34 years.

Homicide was the 16th leading cause of death overall in the United States but disproportionately affected young people (1). It was the third leading cause of death for children aged 1–4 years and persons aged 15–34 years, the fourth leading cause for children aged 5–9 years, and the fifth leading cause for persons aged 10–14 years and 35–44 years. Homicide disproportionately affected young African American males; it was the leading cause of death among those aged 15–34 years.

Public health authorities require accurate, timely, and comprehensive surveillance data to better understand and ultimately prevent the occurrence of violent deaths in the United States (2). In 2000, in response to an Institute of Medicine* report noting the need for a national fatal intentional injury surveillance system (3), CDC began planning to implement the National Violent Death Reporting System (NVDRS) (4). The goals are to

collect and analyze timely, high-quality data for monitoring the magnitude and characteristics of violent deaths at national, state, and local levels;
ensure data are disseminated routinely and expeditiously to public health officials, law enforcement officials, policymakers, and the public;
ensure data are used to develop, implement, and evaluate programs and strategies that are intended to reduce and prevent violent deaths and injuries at national, state, and local levels; and
build and strengthen partnerships among organizations and communities at national, state, and local levels to ensure that data are collected and used to reduce and prevent violent deaths and injuries.

NVDRS was conceived as a state-based active surveillance system that would collect data on the characteristics and circumstances associated with all violence-related deaths in participating states. Deaths would include homicides, suicides, legal intervention deaths (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force but excluding legal executions), unintentional firearm deaths, and deaths of undetermined intent.† The term legal intervention is a classification incorporated into the International Classification of Diseases, Tenth Revision (ICD-10) and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. NVDRS data are used to assist the development, implementation, and evaluation of programs and strategies designed to reduce and prevent these deaths at the national, state, and local levels.

Before implementation of NVDRS, single data sources (e.g., death certificates or law enforcement reports) provided only limited information and few circumstances from which to understand patterns of violent deaths. NVDRS fills this surveillance gap by providing more detailed information. It is the first system to 1) provide detailed information on circumstances precipitating violent deaths, 2) link multiple source documents on violent deaths so that each incident can contribute to the study of patterns of violent deaths, and 3) link multiple deaths that are related to one another (e.g., multiple homicides, suicide pacts, or homicide followed by the suicide of the suspected perpetrator).

In 2003, NVDRS began data collection with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two (Ohio and Michigan) in 2010 (Figure). CDC provides funding for state participation, and the ultimate goal is for NVDRS to expand to include all 50 states, U.S. territories, and the District of Columbia.§

This report summarizes data for 2013 for deaths meeting NVDRS inclusion criteria from the 17 states that collected statewide data in that year (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin); these states account for approximately 30.1% of the U.S. population (1,5). The analysis in this report does not include data from California, which concluded its participation in 2009, and Michigan, which did not collect data statewide during 2013. NVDRS data are updated annually and are available through CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS)¶ at http://www.cdc.gov/injury/wisqars/nvdrs.html.