The National Violent Death Reporting System Deb Karch, Ph.D. Division of Violence Prevention Centers for Disease Control and Prevention The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy

What is NVDRS? Population-based surveillance system Currently in 17 states All violent deaths Multiple source documents are linked Incident level data Focus is violence prevention

NVDRS Case Definition for Violent Death “A death that results from intentional use of force or power, threatened or actual, against oneself, another person, or a group or community.” Source: Krug EG et al., eds. World report on violence and health. Geneva, WHO, 2002.

Scope of NVDRS Intentional Injury Deaths: Unintentional Injury Deaths State definition Intentional Injury Deaths: Suicide (including terrorism) Homicide (including terrorism) Legal intervention (excluding legal executions) Unintentional Injury Deaths Deaths of Undetermined Intent For the most part, then, violent deaths are those where there was an intention to harm. Events of undetermined intent are included because they sometimes would be called suicides or homicides if compared to a standard definition. A lot of the undetermined are poisoning deaths where the MEC has to decide between suicide and unintentional overdose. Different Mes draw this line in different places. Some of them are child deaths where the distinction is between unintentional and homicide. It has beens shown that some of these deaths are actually child abuse homicides on closer inspection. NVDRS Unintentional Firearm Deaths

NVDRS Uses Many Data Sources Primary sources: Death certificates (DC) Coroner/medical examiner (C/ME) records Police records (PR) Crime labs (Lab) Abstractor input Secondary, optional sources: Supplementary Homicide Report (SHR) Hospital records (Hosp) Alcohol Tobacco, Firearms and Explosives (ATF) gun traces

Sample Demographic Data Elements Name SSN Age Sex Race Ethnicity Residence address Birthplace Education Marital status Pregnancy status Veteran’s status Usual occupation Homeless Victim in custody

Sample Event Data Elements Location/date/time of injury Location/date/time of death Address/city/state/zip of injury and death Injured at work EMS on scene Seen in emergency department Admitted to inpatient care Hospital external cause of injury codes Survival time

Sample Medical Data Elements Death certificate number Manner of death ICD-10 Cause of death code Cause/underlying cause/contributing cause of death text Multiple condition codes Autopsy performed Number/location of wounds Toxicology results

Sample Relationship, Weapon and Circumstance Data Elements Victim-suspect relationship codes (up to two) Caretaker of the victim History of abuse of victim Weapon Type (i.e., firearm, sharp instrument) Firearm: make/model/how stored Poisoning: specific drug level Preceding circumstances Suicide unique Homicide unique Unintentional firearm unique

National Standardization The most difficult part of a comprehensive surveillance system Agree on definitions Agree on data elements Create a standardized data collection system Consolidate data into a national data set Conduct national research resulting in comparable state data

An Extremely Important Component of NVDRS Coroner/Medical Examiner and Law Enforcement Narratives

Quantitative vs. Qualitative Data NVDRS collects about 250 unique quantitative variables Easy to analyze Don’t always tell the whole story Qualitative narratives provide a richer data set Identify cases based on a quantitative variable (i.e., NH resident) and greatly enhance your understanding via the narrative

Coroner/Medical Examiner and Law Enforcement Narratives Case Example 1 Coroner/Medical Examiner and Law Enforcement Narratives

Coroner/Medical Examiner Report Narrative The victim, a 59 year old white male, with a history of depression sustained a self-inflicted gunshot wound while a Sheriff's Deputy was in the process of serving an eviction notice. The victim was pronounced at the scene. His medical history included chronic ethanol abuse, obesity, and hypertension. The manner of death is suicide; cause is a gunshot wound to the head.

Police Report Narrative The victim, a 59 year old white male, and his mother had moved into an apartment 9 years ago. The mother died about 5 years ago, and the victim was an excellent tenant until 7 months ago when he stopped paying the rent. The manager notified Adult Protective Services (APS) who sent out a case worker to assist the victim. The only aid he would accept was Old Age Pension and food stamps, but he still did not pay rent. All of the other renters had moved out and the building was undergoing a major renovation. Since the victim had not paid rent, the manager called authorities to see if the victim could be held on a 72 hour hold, or be forced to use social services in some manner but she never received a return call. She started the eviction process. When the sheriff arrived to service the eviction notice, he spoke with the victim who appeared to be in ill health. The victim stated that he had no where to go. It was cold and snowing outside so the sheriff decided not to complete the eviction that day. While he was calling his supervisor the victim shot himself in the head.

Coroner/Medical Examiner and Law Enforcement Narratives Case Example 2 Coroner/Medical Examiner and Law Enforcement Narratives

Coroner/Medical Examiner Report Narrative An 84 year old white female was brought to the emergency room of local hospital and died shortly thereafter of a gunshot wound to the left side of head. A 83 year old white male died of a gunshot wound to the head.

Police Report Narrative Victim A, an 84 year old white female, suffered from Alzheimer's and "sundown syndrome." She had fallen 3 days earlier, cut her head and broken her knee cap. The suspect/victim B was also in declining health. He called their daughter at 0530 and told her that her Mom had kept them up all night and she had ‘lost it’. The daughter suggested putting mom into a nursing home and her father refused to even consider it. A neighbor came to check on victim A at 0830 and found her on the floor by the front door. Rescue personnel determined that the suspect/victim B had shot victim A in the head while they were lying in bed. He then turned the gun on himself and died. Victim A was not deceased yet, got out of bed, got a towel to put on her bleeding head and made it to the front door where she collapsed. She was transported and kept on life support until her children gathered. At that point no further care was provided, life support was removed and she died. Suspect/victim B left a note stating: “Victim A has ‘lost it’, this is the best way out I'm sorry and I love you all.” The victim B was a breast cancer survivor. All reports stated how gentle suspect/victim B was, especially towards his wife. When the daughter got to the hospital, she asked them immediately if her father had shot her mother and then himself.

What We Gain from NVDRS Comprehensive surveillance of violent deaths Quantitative and qualitative data from multiple sources Extensive detail on precipitating circumstances Ability to study the risk and protective factors in violent death Inform primary prevention efforts

Questions?

A Comparison of Male and Female Perpetrators in Single Victim-Single Suspect Homicides: Data from the National Violent Death Reporting System, 2004-2005 Michele C. Black, Ph.D., MPH, Scott Kegler, Ph.D., Debra Karch, Ph.D., Tara Strine, MPH Division of Violence Prevention National Center for Injury Prevention and Control

Background Most homicide studies focus on factors related to victims Studies regarding homicide perpetration have increased in recent years Few studies have included or compare both male and female homicide suspects

Background Examining similarities and differences between male and female homicide suspects and, in general, the full range of relationships between victims and suspects, aids in explaining the context and dynamics of homicide and may aid the development of prevention efforts

Methods Using the National Violent Death Reporting System (NVDRS), we examined differences between males and females regarding Demographics Methods used Location of incident Precipitating circumstances

Why Only Single Victim – Single Suspect Incidents? The dynamics of single victim – single suspect homicides are different from multiple homicide incidents In multiple victim – multiple suspect incidents it may not be possible to know who actually killed whom The relationships of the perpetrators may be complicated (i.e., a woman is assaulted by three males – her friend, his roommate and the roommates cousin who was a stranger to the victim) There remain significant opportunities to study multiple victim – multiple suspect incidents

Results Homicide incidents = 7,562 Single homicide incidents = 6,946 (96.1%) Single homicide with only one suspect = 4,108 (59.1%) Single homicide with only one suspect and suspect sex is known = 3,422 (83.3%) Final N = 3,422

Sex of Victims and Suspects N=3,422 (p=.63) 89.1% involved male suspect 75.6% of these involved a male victim 24.4% involved a female victim 10.9% involved a female suspect 74.5% involved a male victim 25.5% involved a female victim

Age Distribution of Suspect Sex (p < .01)

Age Distribution of Victim by Suspect Sex (p < .01)

Method by Sex of Suspect (p < .01)

Location of Injury by Sex of Suspect (p < .01)

Victim to Suspect Relationship (p < .01)

Precipitating Circumstances of Homicides 40.4% argument (not over money/property) 26.7% IPV-related 16.0% felony related 10.1% drug involvement 8.4% argument (over money or property) 6.3% weapon use by victim 6.0% jealousy 3.5% brawl between three or more people 2.6% self defense

Precipitating Circumstances of IPV and Non-IPV Related Homicides with Male Suspects

Precipitating Circumstances of IPV and Non-IPV Related Homicides with Female Suspects

Summary Male suspects Nearly 90% of suspects were male Peak age of 15 to 24 Killing people of a similar age group 60% Involved a firearm Was as likely to occur outside the home as inside Involved non-family members Female suspects Only 11% of suspects were female Peak age of 35 to 44 Killing persons 0 to 4 years of age Nearly equal use of firearms and sharp instruments Nearly 85% were in the home Involved children or current/former intimate partners

Summary (con’t) Male suspects Female suspects 24% of victims were female with 98% of those IPV related Non-IPV precipitated by argument, felony crime or drugs IPV precipitated by argument over something other than property/money or jealousy Female suspects Both Non-IPV and IPV precipitated primarily by argument over something other than property/money

Conclusions Examining the unique characteristics of suspects and the relationships between victims and suspects aids in explaining the context and dynamics of homicides The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy