"Homicides and Suicides --- National
Violent Death Reporting System, United States, 2003--2004"
Violent deaths claimed 49,639 lives in the United States
during 2003, and the prevention of violent deaths is an
integral part of the public health agenda (1). In 2003,
CDC launched the National Violent Death Reporting System
(NVDRS) to provide detailed information on the circumstances
of violent deaths. The system can be used to develop and
evaluate prevention policies, programs, and strategies
at the national, state, and local levels (2). This report
describes the analysis of violent deaths from seven states
that participated in NVDRS in 2003, plus six additional
states that participated in 2004.
Homicide circumstance information revealed that most
victims knew the suspects involved and that intimate
partner conflicts continued to be among the most important
contributing factors. Suicide circumstance information
indicated that mental health disorders and intimate
partner problems had important roles. These
findings underscore the value of NVDRS data for effective
planning and targeting of violence-prevention programs.
NVDRS is an active, state-based surveillance system
that collects information on homicides, suicides, deaths
of undetermined intent (i.e., those for which available
information is insufficient to enable a medical or legal
authority to make a distinction among unintentional injury,
self-harm, or assault*), deaths from legal intervention
(e.g., involving a person killed by an on-duty police officer),
and unintentional firearm deaths. Seven states provided
data in 2003 (Alaska, Maryland, Massachusetts, New Jersey,
Oregon, South Carolina, and Virginia), and six additional
states contributed in 2004 (Colorado, Georgia, North Carolina,
Oklahoma, Rhode Island, and Wisconsin). NVDRS uses a multisource
approach (i.e., death certificates, coroner/medical examiner
reports, law enforcement records, and crime laboratory
data) for analysis of violent deaths. Using information
from all of these sources, data abstractors in each state
assign a manner of death (i.e., suicide, homicide, unintentional
firearm deaths, legal interventions, and undetermined deaths)
to each case. NVDRS also collects the International Classification
of Diseases, 10th Revision (ICD-10) code for underlying
cause of death (UCOD), circumstances contributing to the
death, and characteristics of the death, including victim-suspect
relationship and victim toxicology results. The UCOD is
categorized as suicide or homicide using standard definitions
from the National Vital Statistics System (NVSS) (3--5).
For 2004, ICD-10 codes for the UCOD were not reported to
NVDRS for 2,773 (19.9%) of the deaths. Because of the high
percentage of missing UCOD codes, this report categorizes
deaths only by the manner of death assigned by abstractors.
The abstractor-assigned manner of death and UCOD ICD-10
codes were consistent in 99.0% and 96.5% of the suicides
and homicides, respectively, in 2003, and 95.3% and 93.1%,
respectively, of the suicides and homicides in 2004. Analysis
of rates was restricted to in-state deaths, including both
residents and nonresidents. This report reflects NVDRS
data collected through June 2005.
The combined seven states collecting 2003 data accounted
for 12.5% of the 2003 U.S. population and for 11.2% of
all suicides and 11.5% of homicides in the United States
during 2003. The 13 states participating in 2004 accounted
for 23.4% of the U.S. population in 2003 and for 23.4%
of all suicides and 22.6% of homicides in the United States
during 2003. By June 2005, the seven states collecting
2003 data had reported 7,732 violent deaths, and the 13
states collecting 2004 data had reported 13,922.
For the seven states that collected data in 2003 and
the 13 that collected data in 2004, suicide accounted for
46.6% (3,603) and 53.0% (7,379) of all NVDRS deaths, respectively.
Nearly 26% of deaths reported in NVDRS in both years (2,023
in 2003 and 3,758 in 2004) were homicides. For both years,
deaths from legal interventions and unintentional firearm
deaths were rare (63 [0.8%] and 54 [0.7%], respectively,
in 2003 and 123 [0.9%] and 104 [0.7%], respectively, in
2004).
Deaths of undetermined intent, as determined by state
medical examiners according to each state's policies, constituted
25.2% (1,951) of cases in 2003 and 14.8% (2,067) in 2004.
The rates of death of undetermined intent varied substantially
among states. The 2004 crude death rate for all 13 reporting
states was 3.0 per 100,000 population, varying from 0.5
per 100,000 population in South Carolina and North Carolina
to 11.0 per 100,000 population in Rhode Island and Maryland.
The variation is attributable, in part, to differences
in state policies for classifying deaths. Suicide
The age-adjusted suicide
rate* for the seven states collecting both 2003 and 2004
data decreased from 9.7 per 100,000 population in 2003
to 9.1 in 2004. In the seven states that collected data
in both 2003 and 2004, the 2004 age-adjusted suicide
rate for men (15.2 per 100,000 population) was more than
four times higher than the rate for women (3.6 per 100,000
population). For the 13 states collecting data in 2004,
the age-adjusted suicide rate for 2004 (10.6 per 100,000
population) was similar to the preliminary rate reported
for the United States overall in NVSS for 2004 (10.7
per 100,000 population) (6). Overall in 2004, the highest
suicide rates were among persons aged >35
years (12.6 per 100,000 population for persons aged 35--64
years and 12.1 per 100,000 population for persons aged >65
years). The highest suicide rate among males was in the >65
years age group (28.9 per 100,000 population); the highest
suicide rate for females was in the 25--64 years age group
(6.9 per 100,000 population).
For the 3,603 reported suicides in 2003, circumstance
information was available for 88.5% (3,189) of cases (Figure
1). For the 7,379 suicides in 2004, information was available
for 80.6% (5,951). Circumstances contributing to suicide
were similar in both years, with nearly half of the suicide
cases involving at least one documented mental health diagnosis.
The most frequently reported mental health diagnoses were
depression (85.2%), bipolar disorder (7.4%), and schizophrenia
(3.3%) in 2004. Roughly half of victims were described
by family or friends as being depressed before the time
of death. Problems with a current or former intimate partner
contributed to 27.9% of suicides. Physical health problems,
most commonly in older adults, contributed to approximately
24.9% of the suicides. Nearly 19.0% of suicide victims
had made previous attempts, and 16.5% had alcohol dependence
problems. Homicide
The age-adjusted homicide
rate* for the seven states collecting both 2003 and 2004
data was 5.6 per 100,000 population in 2003 and 5.1 in
2004. The 2003 and 2004 rates for the United States overall
in NVSS were 6.1 and 5.6 per 100,000 population, respectively
(6,7). For the seven states, the highest rate (12.4 per
100,000 population) was reported among victims aged 15--24
years. Homicide rates tended to decrease with age for
victims aged >24
years. In 2004, the homicide rate for men (8.3 per 100,000
population) was 3.3 times higher than the rate for women
(2.5 per 100,000 population). In 2004, the age-adjusted
homicide rate for the 13 NVDRS states was 5.4 per 100,000
population.
For the 2,023 reported homicides in 2003, circumstance
information was available for 63.2% (1,278) of cases (Figure
2). For the 3,758 homicides in 2004, information was available
for 58.1% (2,183). In 25.5% of cases in 2004, a homicide
was precipitated by a felony-level crime, most frequently
a robbery (44.9%). In 31.8% of these cases, suspects were
known to victims, and 20.0% of homicides were directly
associated with intimate partner conflict (i.e., one in
which an intimate partner killed another partner). Intimate
partner violence resulting in death was most common among
victims aged 40--44 years. Drugs were involved in approximately
16% of homicides in 2004 with known circumstances, most
commonly among victims aged 20--29 years.
Reported by: N Patel, K Webb, D White, Office of Statistics
and Programming; L Barker, A Crosby, M DeBerry, L Frazier,
D Karch, N Lipskiy, K Shaw, M Steenkamp, S Thomas, Div
of Violence Prevention, National Center for Injury Prevention
and Control, CDC. Editorial Note:
Preliminary 2004
national homicide and suicide data from NVSS indicate
a decline in rates from 2003 levels (6); data from
the seven states in NVDRS collecting data in both 2003
and 2004 also indicate a decline. Violent deaths continue
to be among the 10 leading causes of death in the United
States for persons aged <65 years
(3).
Because NVDRS collects circumstance information for
the deaths, the data can be used to describe and monitor
the characteristics of suicide and homicide and the prevalence
of certain risk factors among homicide and suicide victims.
This report demonstrates that mental health disorders and
intimate partner conflicts played the largest roles in
suicide, whereas felony crimes and intimate partner violence
played the largest role in homicide.
The findings in this report are subject to at least
three limitations. First, data for 2003 and 2004 are only
available from a small proportion of U.S. states, although
the intent of NVDRS is to include all U.S. states. Therefore,
these data might not be generalizable to the entire U.S.
population. Second, processes for classifying of the manner
of death differed by jurisdiction. These differences might
be attributed to laws governing death investigations or
medical examiner/coroner practices. For example, although
NVDRS attempts to capture all suicides by investigating
cases and collecting data from multiple sources, certain
suicides might not be identified as such (e.g., when no
evidence of suicidal intent such as a suicide note is present).
Finally, circumstance information is collected through
medical examiner/coroner and law enforcement reports. Families,
friends, and other witnesses might not reveal all the precipitating
circumstances to the investigative agencies, possibly resulting
in inaccurate or incomplete reports.
Numerous circumstances and personal characteristics
contribute to suicides and homicides. NVDRS is the only
surveillance system that regularly collects and consolidates
information from multiple sources on all violent deaths
occurring in participating states. Collecting data on the
circumstances of violent deaths will clarify the association
of personal and social risk factors with violence and how
these factors might change over time (8,9). Thus, NVDRS
is in a unique position not only to evaluate the incidence
of these events but also to enhance understanding of the
associated causes and circumstances. This understanding
can be used to improve risk factor identification and design
programs that might reduce the number of victims. Additional
studies using NVDRS data will allow interpretation of trends
in violent deaths and will help identify potential prevention
strategies.
The findings in this report are based, in part, on contributions
of the 13 funded states that collected violent death data
and their partners, including personnel from law enforcement,
vital records, medical examiners/coroners, and crime laboratories.
Contributions also were made by the NVDRS Team, Office
of Statistics and Programming staff, and other staff at
the National Center for Injury Prevention and Control,
CDC.
References
1. Krug EG, Dahlberg LL, Mercy JA, Zwi A, Lozano R, eds.
World report on violence and health. Geneva, Switzerland:
World Health Organization; 2002.
2. CDC. Homicide and suicide rates---National Violent Death
Reporting System, six states, 2003. MMWR 2005;54:377--80.
3. CDC. Web-based injury statistics query and reporting
system (WISQARS(TM)). Available at http://www.cdc.gov/ncipc/wisqars.
4. Minino AM, Anderson RN, Fingerhut LA, Boudreault MA,
Warner M. Deaths: injuries, 2002. Natl Vital Stat Rep 2006;54(10):1--125.
5. National Center for Health Statistics. ICD-10 framework.
External cause of injury mortality matrix. Hyattsville,
MD: National Center for Health Statistics. Available at http://www.cdc.gov/nchs/about/otheract/ice/matrix10.htm.
6. Minino AM, Heron MP, Smith BL. Deaths: preliminary data
for 2004. Natl Vital Stat Rep 2006;54(19).
7. Hoyert DL, Heron MP, Murphy SL, Kung H. Deaths: final
data for 2003. Natl Vital Stat Rep 2006;54(13).
8. Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE, eds.
Reducing suicide: a national imperative. Washington, DC:
National Academies Press; 2002.
9. CDC. Best practices of youth violence prevention: a
sourcebook for community action. Atlanta, GA: US Department
of Health and Human Services, CDC; 2000.
* World Health Organization. ICD-10 codes online. Available
at http://www3.who.int/icd/currentversion/fr-icd.htm.
* Rates were adjusted to the 2000 U.S. population standard
for age-adjusted death rates (4).
* Rates were adjusted to the 2000 U.S. population standard
for age-adjusted death rates (4). |
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