1. 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

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. 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

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

14. 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.

15. 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.

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

17. 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.

18. 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.

19. 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

20. Questions?

21. A Comparison of Male and Female Perpetrators in Single Victim-Single Suspect Homicides: Data from the National Violent Death Reporting System, 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. Age Distribution of Suspect Sex (p < .01)

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

30. Method by Sex of Suspect (p < .01)

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

32. Victim to Suspect Relationship (p < .01)

33. 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

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

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

36. 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

37. 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

38. 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