National Violent Death Reporting System (NVDRS)Overview and Update

Leroy Frazier, Jr., MSPH, CHESEtiology and Surveillance BranchDivision of Violence Prevention National Center for Injury Prevention and ControlCenters for Disease Control and Prevention

What Do We Know About Violence?>56,000 Americans died from violence in 2001Violence is a particular scourge of the young:Homicide is the second leading cause of death in the 15-24 yrs. age group.Suicide is the second leading cause of death in the 25-34 yrs. age group.

Homicide and Suicide as a Percent of All Deaths by Age Group, US, 2000

Suicide and Homicide Mortality Rates by Age Group, US, 2000

Violent Deaths by Mechanism and Manner, US, 2000

But We Dont Know Enough:Death certificates dont mention suspects and cant combine deaths in the same incidentSupplementary Homicide Reports cover only homicides and carry little informationThe National Incident Based Reporting System has trouble getting law enforcement buy-in

Why Not Just Go to the Original Sources?Law enforcement information describes what happened before deathMedical examiner/coroner files contains information collected after deathDeath certificates describe the person, not what happened.In short, we need something new to compile multiple sources to get the full picture.

The History of NVDRS: 1999 Key stimulus: Institute of Medicine Report recommends the creation of a national fatal intentional injury surveillance system

Early pilot: Six foundations pool private money to start the National Violent Injury Statistics System (NVISS) in academic test tubes

The History of NVDRS: 20002000 NVISS gets under way at 12 sites, mostly universities2000Harvard and the Joyce Foundation convene an expert meeting that suggests the CDC direct a publicly funded system2000 CDC starts planning

NCIPCs Partners in Planning and Executing NVDRSAcademic community: NVISSState health departments: CSTE, STIPDA, NAPHSISNon-CDC Federal agencies: Department of JusticePractitioners: NAME Other CDC: NCHS, EPO (MECISP), NIOSH

Four Principal Data SourcesDeath certificatesPolice reports including Supplementary Homicide Reports (SHRs) or National Incident-Based Reporting System (NIBRS) recordsCoroner and medical examiner recordsCrime lab reports for firearms

A Fifth Data Source Under Development: Child Fatality Review Teams (CFRT)CFRTs merge data on child deaths from the 4 primary sources and multiple othersThey have a particular interest in uncovering violent deathsThey offer unique information on the victims household, caregivers, supervision, and previous contacts with the system

For NVDRS Surveillance Purposes, a Violent Death Is One Classified As:Suicide (including terrorism)Homicide (including terrorism)Legal intervention (excluding executions)Events of undetermined intentUnintentional firearm injury

Scope of NVDRSIntentional / Violent DeathsUnintentional Injury Deaths

NVDRSUndetermined IntentDeathsUnintentionalFirearmDeaths

Flow of Information for NVDRS Med. Exam/CoronerState HealthDept

State agenciesOther Fed. agenciesGeneral publicResearchersPoliceCrimeLabCompleted

Case

Death certificateCDC

NVDRS-Eligible Deaths in US in 2001

*Includes executions, which NVDRS does not include

NVDRS Funding: 2002-2004Feb, 2002 Congresss first appropriation ($1.5 million) Sept, 2002 CDC funds 6 of 17 applying:MA,MD, NJ, OR, SC, and VAFeb, 2003 Second appropriation ($1.5 million)Aug., 2003 CDC funds 7 of 16 applying: AK, CO, GA, NC, OK, RI, WIFeb, 2004 Third appropriation ($725,000 million)

NVDRS States as of May, 2004

FY 02 (6 states)FY 03 (7 states)

Progress to DateImplementation Working Group and Stakeholder Forum have met twiceSoftware has been created and is being used by funded states.Users manuals have been created and are up on the web at www.cdc.gov/ncipcThe first 6 states have collected most of their data from deaths in 2003.Announcement of third round of funded states in August.

Involvement of Vital Records Office at the State LevelSouth Carolinas case initiation takes place in the vital statistics office by a full time staff person funded through the project.

Maryland pays a clerk in the vital records office to pull all cases that meet the program case definition.

Wisconsin pays the vital records office a yearly fee to run copies of all the records that meet the case definition.

The Future for NVDRSSome results will become available in 2004Basic surveillance publications will follow.Incorporation into Public Health Information Network (NEDSS)Eventually all 50 states and territories will be incorporated, assuming funding is available.

For Additional Information, Contact:

Leroy Frazier, Jr., MSPH, CHESNVDRS Project Officer(770) 488-1507Email: Lfrazier1@cdc.gov

By comparison, 40,000 die in motor vehicle crashes and 14,000 die from HIV infection. Both of which have national surveillance systems. Surv for MVC, the FARS, has provided useful information for 30 years.Almost 30% in the 15-24 age group; 55% among black males 15-24 yrs oldFor 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.Some people may mistakenly believe that this is mostly a homicide system. In fact, its roughly 60% suicide, a third homicide, and the rest mostly undetermined.In FY02, 6 states were funded - Alaska, Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin.TOTAL: $1.5 millionIn FY03, 7 additional states were funded - Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia TOTAL: $1.6 million

NOTE: In FY03, 17 states applied for funding.

The NVDRS Forum was launched in 2003 it is a group of external consultants/stakeholders that meets about once per year to receive updates and provide input into the development of the national system.