1. National Violent Death Reporting System (NVDRS): Data Management Challenges and Solutions December 12, 2005 Malinda Steenkamp, M.Phil; Nikolay Lipskiy, Dr.PH (presenter); Division of Violence Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention

2. NVDRS Vision: Reduce and prevent the occurrence of violent deaths in the US through the provision of accurate, timely and comprehensive surveillance data. NVDRS Goals: Collect and analyze timely, high-quality data for monitoring the magnitude and characteristics of violent deaths at the national, state, and local levels Ensure that violent death data are routinely and expeditiously disseminated to public health officials, law enforcement officials, policy makers and the public Provide data for developing, implementing and evaluating strategies, programs and policies designed to prevent violent deaths and injuries at the national, state and local levels Build and strengthen partnerships with organizations and communities at the national, state, and local levels to ensure that data are collected and used to reduce and prevent violent deaths and injuries Expand the National Violent Death Reporting System into all 50 states, the District of Columbia and US territories

3. NVDRS States as of July, 2005 FY 02 (6 states) FY 03 (7 states) FY 04 (4 states)

4. NVDRS Data Sources Primary sources: –Death Certificates (DC) –Coroner/Medical Examiner (C/ME) Records –Police Records (PR) –Crime Lab Data (Lab) Secondary, optional sources: –Child Fatality Review Team Data (CFR) –Supplementary Homicide Reports (SHR) –Hospital (HOSP) Data –Emergency Department (ED) Data –Alcohol Tobacco, Firearms and Explosives (ATF) Trace Information on Firearms

5. National Violent Death Reporting System NVDRS collects data on all violent deaths Suicides (including terrorism-related deaths) Homicides (including terrorism-related deaths) Legal intervention Some others: –Deaths of undetermined intent –Deaths due to unintentional firearm injury Excluded: acts of war and legal executions Case initiation: Abstractors initiate cases through analysis of the source specific manners of deaths, w/o ICD-10 codes

6. Operational Definition: ICD-10 Codes that Define NVDRS Cases Manner of Death Death <1 yr after Injury Death >1 yr after Injury Intentional self harmX60-X84Y87.0 AssaultX85-X99, Y00-Y09Y87.1 Undetermined intentY10-Y34Y87.2, Y89.9 Unintentional firearmW32-W34Y86 (guns) Legal interventionY35.0-Y35.7 except Y35.5 Y89.0 Terrorism*U01, *U03*U02 Excluded: acts of war and legal executions

7. NVDRS: Case Initiation and ICD-10 Codes

8. How Does NVDRS Work? Med. Exam/ Coroner Software contractor Disseminate findings and data in various ways Law enforcement (Police reports) (SHR + NIBRS) Crime Lab Case Info (- identifiers) Vital Records (Death certificate) NVDRS (CDC) State VDRS (17 states) Other Also back to providers

9. What Data Are Collected? Incident (# of persons, mechanisms, PR/CME narratives) Persons: Victims Alleged perpetrators Victim-Perpetrator Relationships Mechanisms Person-Mechanism Relationships Victims: Demographics Other personal data (residence, marital status, pregnant, occupation) Injury event (location, county) Death (location, manner, cause) Related factors (toxicology) Circumstances: - Suicide/Undetermined deaths - Homicide - Unintentional firearms Alleged perpetrators: Demographics Mechanism type - Firearm - Poisonings - Hanging, strangulation, suffocation History of abuse Caretaker V-P relationship (for all pairs) Person used this weapon to kill Weapon killed this person First purchaser

10. Screen Shot of NVDRS Software

11. Incident tables Document table SV relationship PW relationship Person tables Weapon tables

12. NVDRS’ PUD Structure IncidentsDeaths Suspects State reporting incident Resident incident Incident type # of persons in incident # of weapons # of deaths # of suspects Person type Demographics Pregnancy status Homeless status State reporting incident Type of location where injured Injured at home/work Manner of death ICD-10 manner of death 358/113/39 cause of death recode Person attempted suicide after incident History of abuse Caretaker of victim Victim to suspect relationship Weapon type Firearm type Poison type State reporting incident Person type Record type Demographics

13. Approach To Analyze NVDRS Data Created 6 data analysis files based on six entities: –Incident –Person (Victims, Suspect/Victims, Suspects) –Weapon –Victim – Suspect Relationship –Person – Weapon Relationship –Document All files includes linking variables –Site ID, Incident ID –Will also include person ID in future Files can be combined/merged as needed

14. Analyzing NVDRS Data Different ways to identify cases –5 manners of death (DC, CME, Abstractor, ICD-10, CDC Manner) At different points in time – completion rates for manner differ (ICD-10 more incomplete for longer) Abstractor assigned manner is a gateway variable

15. Analyzing NVDRS Data (cont.) Need to know that there are gateway variables –Abstractor assigned manner –Person type –Circumstances known –Weapon type (not discussed today) Need to know how to use these: –Person type When looking at deaths - Select person types 1 (Victim) and 3 (Suspect/Victim) (Person type 2 = live suspects)

16. CDC Analysis Variables Similar variables – multiple sources – combine Example for sex data element: –Variable comes from four data sources DC, CME, SHR, PR, –Rule of primacy Created a CDC analysis variable (combined variable) Identified by _c (e.g. Sex_C)

17. Preliminary NVDRS Data: First and Second Data Year Frequency 2003 (June 05) 2004 (June 05) # of States713 Months collecting2715 # of Incidents7,55313,850 # of Deaths7,73613,923 # of Live Suspects2,0343,027 *Six states were funded to start data collection in 2003, Alaska was funded to start data collection in 2004, but they chose to go back and also collect data on 2003.

18. Data element and categories Suicide (n=3,564) Homicide (N=2,009) Place of injuryHouse/apartment Street/road Natural area Motor vehicle 72.4% 1.7% 6.0% 4.5% 41.0% 30.8% 2.0% 4.0% At/during workYes1.5%3.7% Alcohol use suspectedYes34.4%33.3% CME Circumstances known Yes81.1%49.3% Preliminary NVDRS Results: Injury Event; 2003; 7 States NVDRS, as of March 2005

19. Preliminary Homicide Results: Victim to Suspect Relationship; 2003; 7 States V-S Relationship Percent Intimate partner28.1 Parent4.6 Child6.8 Other family/caretaker8.0 Friend/other known person 32.0 Stranger7.8 Other12.8 NVDRS, as of March 2005

20. Next Steps Develop strategic planning process incorporating data management tasks Develop and release 2003 and 2004 PUDs Incorporate NVDRS into Public Health Information Network (PHIN/NEDSS) Continue to work on a data aggregation model Use NVDRS data to guide and enhance violence prevention efforts

21. Summary NVDRS improves quality and completeness of violent death data through the timely collection and aggregation of multi-source information Major pitfalls data collection and management: - Involvement of different agencies - Need a standardization of data element definitions across all agencies - The development and implementation of QA methods for data collection and management, from a multi-source perspective, is a complex problem Major data management challenges: - development of a data management model for the population-based violent death surveillance system - development of a reliable violent death data source for the public health - to grow towards becoming a comprehensive public health measurement tool

22. For Additional Information, Contact: Malinda Steenkamp, M.Phil NVDRS Senior Advisor (770) 488-4476 Email: Msteenkamp@cdc.govMsteenkamp@cdc.gov Nikolay Lipskiy, MPH, MBA, DrPH NVDRS Epidemiologist (770) 488-1306 Email: dgz1@cdc.govdgz1@cdc.gov