1. National Violent Death Reporting System (NVDRS) Overview and Update Leroy Frazier, Jr., MSPH, CHES Etiology and Surveillance Branch Division of Violence Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention

2. What Do We Know About Violence? >56,000 Americans died from violence in 2001 Violence 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.

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

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

5. Violent Deaths by Mechanism and Manner, US, 2000

6. …But We Don’t Know Enough: Death certificates don’t mention suspects and can’t combine deaths in the same incident Supplementary Homicide Reports cover only homicides and carry little information The National Incident Based Reporting System has trouble getting law enforcement buy-in

7. Why 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.

8. 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

9. The History of NVDRS: 2000 2000 NVISS gets under way at 12 sites, mostly universities 2000Harvard and the Joyce Foundation convene an expert meeting that suggests the CDC direct a publicly funded system 2000 CDC starts planning

10. NCIPC’s Partners in Planning and Executing NVDRS Academic community: NVISS State health departments: CSTE, STIPDA, NAPHSIS Non-CDC Federal agencies: Department of Justice Practitioners: NAME Other CDC: NCHS, EPO (MECISP), NIOSH

11. Four 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 reports for firearms

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

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

14. Scope of NVDRS Intentional / ”Violent” Deaths Unintentional Injury Deaths NVDRS Undetermined Intent Deaths Unintentional Firearm Deaths

15. Flow of Information for NVDRS Occurrence of a violent death Med. Exam/ Coroner State Health Dept State agencies Other Fed. agencies General public Researchers Polic e Crime Lab Completed Case Death certificate CDC

16. NVDRS-Eligible Deaths in US in 2001 Manner of DeathNo. Pct. Suicide 30,622 54.4 Homicide 17,382 30.8 Terrorism-related homicides2,9265.2 Undetermined intent 4,198 7.4 Unintentional firearm injury 802 1.4 Legal intervention 396 0.7 TOTAL 56,326 100.0

17. NVDRS Funding: 2002-2004 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 ($1.5 million) Aug., 2003 CDC funds 7 of 16 applying: AK, CO, GA, NC, OK, RI, WI Feb, 2004 Third appropriation ($725,000 million)

18. NVDRS States as of May, 2004 FY 02 (6 states) FY 03 (7 states)

19. Progress to Date Implementation Working Group and Stakeholder Forum have met twice Software 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/ncipcwww.cdc.gov/ncipc The first 6 states have collected most of their data from deaths in 2003. Announcement of third round of funded states in August.

20. Involvement of Vital Records Office at the State Level South Carolina’s 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.

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

22. For Additional Information, Contact: Leroy Frazier, Jr., MSPH, CHES NVDRS Project Officer (770) 488-1507 Email: Lfrazier1@cdc.gov