Violent deaths in Rhode Island, 1999-2002

Violent deaths in Rhode Island, 1999-2002

Buechner, Jay S

In 2000, there were nearly 51,000 deaths nationally caused by non-accidental violence, including homicides, suicides, and other violence.1 Other major categories of injury deaths have federally-supported data systems drawing on multiple sources to support epidemiologic studies and program evaluations, despite comprising fewer deaths per year than violence. For motor vehicle deaths, the National Highway Traffic Safety Administration (NHTSA) has sponsored the Fatality Analysis and Reporting System (FARS) for several decades. For occupational injury deaths, the Bureau of Labor Statistics developed the Census of Fatal Occupational Injuries (CFOI) early in the last decade.

The Institute of Medicine recommended that a similar system be developed for violent deaths in its 1999 report, Reducing the Burden of Injuries.2 In response, the Injury Control Research Center at the Harvard School of Public Health, with support from the Centers for Disease Control and Prevention (CDC), performed a pilot study, the National Violent Injury Surveillance System (NVISS), which included both fatal and non-fatal injuries. Subsequently, Congress mandated the development of the National Violent Death Reporting System (NVDRS) in the FY2002 federal budget. In the first year of the NVDRS, the CDC enrolled six states; in FY2003, Congress appropriated funding to add eight more states. As designed by the CDC, the NVDRS assembles and links information on each violent death from four sources: Death certificates, Medical Examiner investigations, police crime reports, and crime laboratory findings. The Rhode Island Department of Health has applied to join the NVDRS and has analyzed death certificate data and Medical Examiner data for 1999-2002 in support of its application.

Methods

Violent deaths occurring in Rhode Island in 1999-2002 were identified in the Vitals Records death files using the underlying cause of death (UCOD) codes specified by the NVDRS. (Table 1) Cases were aggregated by patient demographics (age, sex, race, and place of residence) and by information from the UCOD on intent to injure (assault, self-inflicted, unintentional, undetermined) and mechanism of injury (firearms, suffocation, poisoning, etc.).3 [Note: The large majority of deaths of undetermined intent are deaths due to overdoses of drugs, including prescription, over-the-counter, and illegal drugs, where possible suicidal intent and accident could not be distinguished. Such deaths are included in the broad definition of violence used in the NVDRS.]

Results

There were 776 deaths in Rhode Island during 1999-2002 that meet the NVDRS definitions for violent deaths, an average of 194 deaths per year. Of these, the largest proportion were suicides (82.5 per year), followed by deaths from drug oversodes or other undetermined intent (66 per year), homicides (39.3 per year), late effects of injuries (6.0 per year), and other firearms injuries (0.3 per year). (Figure 1)

Violent deaths in the state were clustered among residents ranging in age from adolescence to middle age. (Figure 2) Median age at death was 38 years; median ages for suicides (41 years) and deaths from drug overdoses or other undetermined intent (40 years) were higher than for homicides (27 years). By gender, 74.2% were male. By race and ethnicity, the proportion of violent deaths among African-Americans (10.6%) was higher than the proportion of African-Americans in the 2000 Census for Rhode Island (4.5%).

The mechanism of injury varied greatly according to the characterization of intent. Among homicides, the majority of deaths (63.7%) were caused by firearms injuries; among suicides, the proportion caused by firearms was lower (35.5%), and there were no deaths of undetermined intent from firearms. (Figure 3) Deaths caused by sharp force such as knives were most common among homicides (17.2%), much less common among suicides (1.8%), and not appearing at all among deaths of undetermined intent. Conversely, there were no homicides by drug overdoses or poisoning, but this category comprised the third most common mechanism of suicide (17.6%) and nearly all (91.7%) deaths of undetermined intent. Death by asphyxiation (hanging, suffocation) was far more common among suicides (34.2%) than among homicides (1.8%) or deaths of undetermined intent (1.1%).

Discussion

Death rates for injuries, including violent injuries, are generally lower in Rhode Island than nationally,4 but these deaths occur among residents in their most productive years and hence represent a substantial burden of premature mortality. It is likely that many of these deaths are preventable through a variety of proven public health interventions that address violent and suicidal behaviors and complement law enforcement, mental health, and substance abuse prevention activities.

If the Rhode Island application to participate in the NVDRS is successful, the substantial additional information assembled on the violent deaths occurring here will meet a number of goals. It will help reveal the underlying patterns of violence and suicide, support the development of violence and suicide prevention strategies and programs, and allow the scientific evaluation of those programs’ success. Participation in the NVDRS will help establish partnerships between public health and other organizations involved in violence prevention in the state and municipalities, notably law enforcement agencies. And it will enhance federal-state collaborations against violence through the sharing of surveillance data and evaluation results.

Copyright Rhode Island Medical Society Aug 2003

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