The National Violent Death Reporting System (NVDRS)BackgroundHomicide and Suicide as a Percent of All Deaths by Age Group, US, 2000…But We Don’t Know Enough:Why Not Just Go to the Original Sources?The NVDRSThe History of the NVDRSHistory – ContinuedFinally, NVDRS Is BornSlide 10The NVDRS is a multi-source violent death surveillance systemConceptual Definition of a “Violent Death”For Surveillance, the Operational Definition of a Violent DeathICD-10 Codes that Define NVDRS CasesViolent Deaths in US Residents in 2000A State’s Scope includes Both Resident and Occurrent DeathsIncident-based SystemFour Principal Data SourcesSlide 19The Death Certificate Typically Starts the Case-finding ProcessInformation Collected from the Death CertificateCoroner/Medical Examiner information is an important second sourceTypes of Information Recorded from C/ME Records into NVDRSLaw Enforcement Records are another source of information in NVDRSTypes of Information Recorded from Law Enforcement Records into NVDRSInformation Collected from Crime LabsData Elements in NVDRSData Elements OverlapSlide 29A Fifth Data Source Under Development: Child Fatality Review Teams (CFRT)Preliminary NVDRS ResultsPreliminary NVDRS Results: Manner of Death; 13 states, 2004, N=13Preliminary Homicide Results: Injury event; 2004, 13 statesThe Future for NVDRSThe National Violent Death Reporting System (NVDRS)Thomas Songer, PhD, MSc, MPHUniversity of PittsburghBackground•>50,000 Americans died from violence in 2000•Violence is a particular scourge of the young:–Homicide is the second leading cause of death in the 1-34 yrs age group.–Suicide is the third leading cause of death in this age group.Paulozzi, FrazierHomicide and Suicide as a Percent of All Deaths by Age Group, US, 20000102030405060<1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+Age Group (yrs.)Pct. of All DeathsAllBlack MalesPaulozzi, Frazier…But We Don’t Know Enough:•Death certificates don’t mention suspects and can’t combine deaths in one incident•Supplementary Homicide Reports cover only homicides and carry little information•The National Incident Based Reporting System has trouble getting law enforcement buy-in in addition to other deficienciesPaulozzi, FrazierWhy Not Just Go to the Original Sources?•Law enforcement information describes what happened before death•Medical examiner/coroner files contains information collected after death•Death certificates describe the person, not what happened.•In short, we need something new to compile multiple sources to get the full picture.Paulozzi, FrazierThe NVDRSThe History of the NVDRS •Conception: 1999 Institute of Medicine Report recommends the creation of a national fatal intentional injury surveillance system•Early pilot: 1999 Six foundations start the National Violent Injury Statistics System (NVISS) in academic test tubesPaulozzi, FrazierHistory – Continued•2000 NVISS gets under way at 12 sites, mostly universities•2000 Harvard and the Joyce Foundation convene an expert meeting that suggests the CDC direct a publicly funded system•2000 CDC starts planning Paulozzi, FrazierFinally, NVDRS Is Born•Feb, 2002 Congress’s first appropriation ($1.5 million) •Sept, 2002 CDC funds 6 of 17 applying:MA,MD, NJ, OR, SC, and VA•Feb, 2003 Second appropriation•Aug., 2003 CDC funds 7 of 16 applying: AK, CO, GA, NC, OK, RI, WIPaulozzi, FrazierNVDRS States as of 2005FY 02 (6 states)FY 03 (7 states)FY 04 (4 states)The NVDRS is a multi-source violent death surveillance systemConceptual Definition of a“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.Paulozzi, FrazierFor Surveillance, the Operational Definition of a Violent Death•Underlying cause of death must be coded to homicide, suicide, undetermined intent, legal intervention, unintentional firearm injury, or terrorism.•Deaths prior to birth due to violence, ie, fetal deaths, are not included. In other words, the victim must have a standard death certificate, not a fetal death certificate.Paulozzi, FrazierICD-10 Codes that Define NVDRS Cases*U02*U01, *U03TerrorismY89.0Y35.0-Y35.7 except Y35.5Legal interventionY86 (guns)W32-34Unintentional firearmY87.2, Y89.9Y10-34Undetermined intentY87.1X85-99, Y00-09AssaultY87.0X60-84Intentional self harmDeath >1 yrafter InjuryDeath <1 yrafter InjuryUnderlying Cause of DeathPaulozzi, FrazierViolent Deaths in US Residents in 2000Manner of Death No. Pct.Suicide 29,350 57.6Homicide 16,765 32.9Undetermined 3,819 7.5Unintentional Firearm Injury 776 1.5Legal Intervention exc. Executions 274 0.5Terrorism NA NATOTAL 50,984 100.0Paulozzi, FrazierA State’s Scope includes Both Resident and Occurrent Deaths•Resident deaths are needed for population-based rates.•Occurrent deaths allow mapping of where violence is occurring, not where victims of violence live.•If a victim lives in one state and dies in another, and resident and occurrent states are both NVDRS states, the occurrent state is responsible for collecting the death.Paulozzi, FrazierIncident-based System•Unlike most public health surveillance systems, NVDRS uses the “incident” as the unit of surveillance.–A single violent death, e.g., a suicide, constitutes an incident. –Multiple people who are victims or suspects in violent deaths also constitute an incident if they are connected and the injuries occur within a 24-hour period.•This allows capture of causal relationships among deaths and description of the social relationships involved.•It still allows each death to be used as a unit of analysis, e.g., in death rates.Paulozzi, FrazierFour Principal Data Sources•Death certificates•Police reports including Supplementary Homicide Reports (SHRs) or National Incident-Based Reporting System (NIBRS) records•Coroner and medical examiner records•Crime lab reportsPaulozzi, FrazierFlow of Information for the National Violent Death Reporting System Occurrence of a violent deathMed. Exam/CoronerState HealthDeptState agenciesOther Fed. agenciesGeneral publicResearchersPoliceCrimeLabCompleted IncidentDeath certificateCDCPaulozzi, FrazierThe Death Certificate Typically Starts the Case-finding Process•Deaths meeting the case definition are identified from those received at