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Table 1.  

Characteristic Male Female Total
No. (%) Rate No. (%) Rate No. (%) Rate
Age group (yrs)
10–14 280 (1.0) 3.7 152 (2.0) 2.1 432 (1.2) 2.9
15–19 1,353 (5.0) 17.5 394 (5.2) 5.3 1,747 (5.0) 11.5
20–24 2,311 (8.5) 28.6 496 (6.5) 6.4 2,807 (8.1) 17.7
25–29 2,392 (8.8) 27.6 572 (7.5) 6.9 2,965 (8.5) 17.4
30–34 2,224 (8.2) 27.6 623 (8.2) 7.9 2,848 (8.2) 17.9
35–44 4,183 (15.4) 28.4 1,259 (16.5) 8.5 5,442 (15.7) 18.4
45–54 4,480 (16.5) 30.2 1,530 (20.1) 10.0 6,010 (17.3) 20.0
55–64 4,678 (17.3) 31.4 1,504 (19.7) 9.4 6,182 (17.8) 20.0
65–74 2,766 (10.2) 26.9 738 (9.7) 6.3 3,504 (10.1) 15.9
75–84 1,691 (6.2) 35.3 243 (3.2) 3.9 1,934 (5.6) 17.5
≥85 737 (2.7) 44.4 104 (1.4) 3.4 841 (2.4) 17.7
Unknown 13 (<1.0) †† 1 (<1.0) 14 (<1.0)
Race/Ethnicity
White, non-Hispanic 21,960 (81.0) 32.7 6,124 (80.4) 8.8 28,086 (80.9) 20.5
Black, non-Hispanic 1,925 (7.1) 14.9 509 (6.7) 3.5 2,434 (7.0) 8.9
American Indian or Alaska Native, non-Hispanic 413 (1.5) 45.6 124 (1.6) 12.9 537 (1.5) 28.8
Asian or Pacific Islander, non-Hispanic 749 (2.8) 12.7 328 (4.3) 5.0 1,077 (3.1) 8.7
Hispanic§§ 1,979 (7.3) 13.7 507 (6.7) 3.6 2,486 (7.2) 8.7
Other race or ethnicity 64 (<1.0) 23 (<1.0) 87 (<1.0)
Unknown 18 (<1.0) 1 (<1.0) 19 (<1.0)
Method
Firearm 14,493 (53.5) 14.3 2,234 (29.3) 2.1 16,727 (48.2) 8.1
Hanging, strangulation, or suffocation 7,873 (29.0) 7.8 2,360 (31.0) 2.2 10,235 (29.5) 4.9
Poisoning 2,078 (7.7) 2.1 2,230 (29.3) 2.1 4,308 (12.4) 2.1
Fall 639 (2.4) 0.6 236 (3.1) 0.2 875 (2.5) 0.4
Sharp instrument 548 (2.0) 0.5 124 (1.6) 0.1 672 (1.9) 0.3
Motor vehicle (e.g., bus, motorcycle, or other transport vehicle) 445 (1.6) 0.4 119 (1.6) 0.1 564 (1.6) 0.3
Drowning 206 (<1.0) 0.2 121 (1.6) 0.1 327 (<1.0) 0.2
Fire or burns 106 (<1.0) 0.1 40 (<1.0) <0.1 146 (<1.0) <0.1
Blunt instrument 34 (<1.0) <0.1 11 (<1.0) 45 (<1.0) <0.1
Other (e.g., Taser, electrocution, nail gun, intentional neglect, or personal weapon) 39 (<1.0) 14 (<1.0) 53 (<1.0)
Unknown 647 (2.4) 127 (1.7) 774 (2.2)
Location
House or apartment 18,958 (69.9) 18.7 5,962 (78.3) 5.6 24,921 (71.8) 12.0
Motor vehicle 1,474 (5.4) 1.5 309 (4.1) 0.3 1,784 (5.1) 0.9
Natural area 1,376 (5.1) 1.4 262 (3.4) 0.3 1,638 (4.7) 0.8
Hotel or motel 562 (2.1) 0.6 225 (3.0) 0.2 787 (2.3) 0.4
Street or highway 674 (2.5) 0.7 105 (1.4) 0.1 779 (2.2) 0.4
Park, playground, or sports or athletic area 468 (1.7) 0.5 62 (<1.0) <0.1 530 (1.5) 0.3
Parking lot, public garage, or public transport 431 (1.6) 0.4 75 (<1.0) <0.1 506 (1.5) 0.2
Jail or prison 432 (1.6) 0.4 47 (<1.0) <0.1 479 (1.4) 0.2
Bridge 229 (<1.0) 0.2 69 (<1.0) <0.1 298 (<1.0) 0.1
Railroad track 179 (<1.0) 0.2 60 (<1.0) <0.1 239 (<1.0) 0.1
Commercial or retail area 196 (<1.0) 0.2 27 (<1.0) <0.1 223 (<1.0) 0.1
Supervised residential facility 109 (<1.0) 0.1 38 (<1.0) <0.1 147 (<1.0) <0.1
Hospital or medical facility 100 (<1.0) 0.1 27 (<1.0) <0.1 127 (<1.0) <0.1
Cemetery, graveyard, or other burial ground 84 (<1.0) <0.1 13 (<1.0) 97 (<1.0) <0.1
Industrial or construction area 87 (<1.0) <0.1 8 (<1.0) 95 (<1.0) <0.1
Preschool, school, college, or school bus 79 (<1.0) <0.1 16 (<1.0) 95 (<1.0) <0.1
Farm 89 (<1.0) <0.1 6 (<1.0) 95 (<1.0) <0.1
Other location¶¶ 474 (1.7) 67 (<1.0) 541 (1.6)
Unknown 1,107 (4.1) 238 (3.1) 1,345 (3.9)
Total 27,108 (100.0) 26.8 7,616 (100.0) 7.2 34,726 (100.0) 16.8

Table 1. Number, percentage,* and rate of suicides among persons aged ≥10 years,§ by selected demographic characteristics of decedent, method used, and location in which injury occurred — National Violent Death Reporting System, 39 states and the District of Columbia, 2018**

* Percentages might not total 100% due to rounding.
Per 100,000 population.
§ Suicide is not reported for decedents aged <10 years, as per standard in the suicide prevention literature. Denominators for suicide rates represent the total population aged ≥10 years.
Sex was unknown for two decedents.
** Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humstrongt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
†† Rate is not reported when the number of decedents is <20 or when the characteristic response is “other” or “unknown.”
§§ Includes persons of any race.
¶¶ Other location includes (in descending order) office building; abandoned house, building, or warehouse; synagogue, church, or temple; bar or nightclub; and other unspecified location.

Table 2.  

Toxicology variable Tested Positive
No. (%) No. (%)
Blood alcohol concentration 18,179 (52.3) 7,240 (39.8)
Alcohol <0.08 g/dL   2,003 (27.7)
Alcohol ≥0.08 g/dL   4,636 (64.0)
Alcohol positive — level unknown   601 (8.3)
Amphetamines 14,328 (41.3) 1,996 (13.9)
Anticonvulsants 7,668 (22.1) 1,180 (15.4)
Antidepressants 9,793 (28.2) 3,516 (35.9)
Antipsychotics 7,516 (21.6) 842 (11.2)
Barbiturates 12,248 (35.3) 260 (2.1)
Benzodiazepines 14,288 (41.1) 3,513 (24.6)
Carbon monoxide 2,041 (5.9) 684 (33.5)
Cocaine 14,510 (41.8) 1,039 (7.2)
Marijuana 12,297 (35.4) 2,896 (23.6)
Muscle relaxant 7,853 (22.6) 490 (6.2)
Opioids 15,210 (43.8) 3,449 (22.7)
Other drugs or substances** 7,583 (21.8) 6,571 (86.7)

Table 2. Number* and percentage of suicide decedents tested for alcohol and drugs whose results were positive, by toxicology variable — National Violent Death Reporting System, 39 states and the District of Columbia, 2018§

* Number of suicide decedents = 34,726.
Percentage is of decedents tested for toxicology. Denominator for the percentage positive is the percentage tested.
§ Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
Blood alcohol concentration of ≥0.08 g/dL is greater than the legal limit in all states and the District of Columbia and is used as the standard for intoxication.
** Other drugs or substances indicated whether any results were positive; levels for these drugs or substances are not measured.

Table 3.  

Precipitating circumstance Male Female Total
No. (%) No. (%) No. (%)
Mental health or substance use
Current diagnosed mental health problem** 10,736 (45.3) 4,495 (64.7) 15,233 (49.7)
      Depression or dysthymia 7,972 (74.3) 3,457 (76.9) 11,431 (75.0)
      Anxiety disorder 1,905 (17.7) 1,126 (25.1) 3,032 (19.9)
      Bipolar disorder 1,388 (12.9) 877 (19.5) 2,265 (14.9)
      Schizophrenia 690 (6.4) 219 (4.9) 909 (6.0)
      PTSD 611 (5.7) 187 (4.2) 798 (5.2)
      ADD/ADHD 379 (3.5) 68 (1.5) 447 (2.9)
      OCD 70 (<1.0) 21 (<1.0) 91 (<1.0)
      Eating disorder 9 (<1.0) 29 (<1.0) 38 (<1.0)
      Other 690 (6.4) 222 (4.9) 912 (6.0)
      Unknown 815 (7.6) 356 (7.9) 1,171 (7.7)
History of ever being treated for a mental health problem 7,608 (32.1) 3,461 (49.8) 11,070 (36.1)
Current depressed mood 8,127 (34.3) 2,384 (34.3) 10,511 (34.3)
Current mental health treatment 5,311 (22.4) 2,679 (38.6) 7,991 (26.1)
Alcohol problem 4,690 (19.8) 1,099 (15.8) 5,789 (18.9)
Substance use problem (excludes alcohol) 4,034 (17.0) 1,249 (18.0) 5,283 (17.2)
Other addiction (e.g., gambling or sexual) 158 (<1.0) 42 (<1.0) 200 (<1.0)
Interpersonal
Intimate partner problem 6,621 (27.9) 1,655 (23.8) 8,277 (27.0)
Family relationship problem 2,027 (8.5) 793 (11.4) 2,820 (9.2)
Other death of family member or friend 1,523 (6.4) 543 (7.8) 2,066 (6.7)
Suicide of family member or friend 582 (2.5) 236 (3.4) 818 (2.7)
Perpetrator of interpersonal violence during past month 648 (2.7) 59 (<1.0) 707 (2.3)
Other relationship problem (nonintimate) 499 (2.1) 132 (1.9) 631 (2.1)
Victim of interpersonal violence during past month 61 (<1.0) 77 (1.1) 138 (<1.0)
Life stressor
Crisis during previous or upcoming 2 weeks 7,583 (32.0) 1,835 (26.4) 9,419 (30.7)
Physical health problem 5,121 (21.6) 1,397 (20.1) 6,518 (21.3)
Argument or conflict 3,753 (15.8) 1,123 (16.2) 4,876 (15.9)
Job problem 2,447 (10.3) 417 (6.0) 2,864 (9.3)
Financial problem 2,187 (9.2) 505 (7.3) 2,693 (8.8)
Recent criminal legal problem 2,176 (9.2) 233 (3.4) 2,409 (7.9)
Eviction or loss of home 864 (3.6) 262 (3.8) 1,127 (3.7)
Non-criminal legal problem 874 (3.7) 238 (3.4) 1,112 (3.6)
School problem 375 (1.6) 123 (1.8) 498 (1.6)
History of child abuse or neglect 223 (<1.0) 141 (2.0) 364 (1.2)
Physical fight (two persons, not a brawl) 250 (1.1) 42 (<1.0) 292 (<1.0)
Traumatic anniversary 151 (<1.0) 67 (<1.0) 218 (<1.0)
Exposure to disaster 58 (<1.0) 4 (<1.0) 62 (<1.0)
Caretaker abuse or neglect led to suicide 15 (<1.0) 15 (<1.0) 30 (<1.0)
Crime and criminal activity
Precipitated by another crime 1,030 (4.3) 92 (1.3) 1,122 (3.7)
      Crime in progress†† 348 (33.8) 27 (29.3) 375 (33.4)
Suicide event
History of suicidal thoughts or plans 8,042 (33.9) 2,692 (38.8) 10,735 (35.0)
Left a suicide note 7,471 (31.5) 2,765 (39.8) 10,238 (33.4)
History of suicide attempt(s) 3,895 (16.4) 2,321 (33.4) 6,217 (20.3)
Suicide disclosure
Disclosed suicidal intent§§ 5,759 (24.3) 1,635 (23.5) 7,395 (24.1)
      To previous or current intimate partner 2,246 (39.0) 544 (33.3) 2,790 (37.7)
      To other family member 1,702 (29.5) 528 (32.3) 2,230 (30.1)
      To friend or colleague 687 (11.9) 218 (13.3) 905 (12.2)
      To health care worker 238 (4.1) 88 (5.4) 327 (4.4)
      To neighbor 65 (1.1) 24 (1.5) 89 (1.2)
      To other person 492 (8.5) 118 (7.2) 610 (8.2)
      Unknown 332 (5.8) 115 (7.0) 447 (6.0)
Total¶¶ 23,723 (87.5) 6,943 (91.2) 30,668 (88.3)

Table 3. Number* and percentage of suicides among persons aged ≥10 years,§ by decedent’s sex and precipitating circumstance — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

Abbreviations: ADD/ADHD = attention deficit disorder/attention deficit hyperactivity disorder; OCD = obsessive-compulsive disorder; PTSD = posttraumatic stress disorder.
* Includes suicides with one or more precipitating circumstances. More than one circumstance could have been present per decedent.
Denominator includes those suicides with one or more precipitating circumstances. The sums of percentages in columns exceed 100% because more than one circumstance could have been present per decedent.
§ Suicide is not reported for decedents aged <10 years, as per standard in the suicide prevention literature.
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
** Includes decedents with one or more diagnosed current mental health problems; therefore, sums of percentages for the diagnosed conditions exceed 100%. Denominator includes the number of decedents with one or more current diagnosed mental health problems.
†† Denominator includes those decedents involved in an incident that was precipitated by another crime.
§§ Denominator includes decedents who disclosed intent.
¶¶ Circumstances were unknown for 4,058 decedents (3,385 males and 673 females); total number of suicide decedents = 34,726 (27,108 males, 7,616 females, and two unknown).

Table 4.  

Characteristic Male Female Total
No. (%) Rate No. (%) Rate No. (%) Rate
Age group (yrs)
<1 115 (1.1) 8.2 84 (3.0) 6.3 199 (1.5) 7.3
1–4 149 (1.4) 2.6 105 (3.7) 1.9 254 (1.9) 2.2
5–9 44 (<1.0) 0.6 32 (1.1) 0.5 76 (<1.0) 0.5
10–14 56 (<1.0) 0.7 43 (1.5) 0.6 99 (<1.0) 0.7
15–19 1,022 (9.6) 13.2 182 (6.4) 2.5 1,204 (9.0) 8.0
20–24 1,764 (16.6) 21.8 317 (11.2) 4.1 2,081 (15.5) 13.2
25–29 1,840 (17.3) 21.3 326 (11.5) 3.9 2,166 (16.1) 12.7
30–34 1,344 (12.7) 16.7 276 (9.7) 3.5 1,620 (12.1) 10.2
35–44 1,925 (18.1) 13.1 470 (16.6) 3.2 2,395 (17.8) 8.1
45–54 1,124 (10.6) 7.6 365 (12.9) 2.4 1,489 (11.1) 4.9
55–64 739 (7.0) 5.0 277 (9.8) 1.7 1,016 (7.6) 3.3
65–74 328 (3.1) 3.2 194 (6.9) 1.7 522 (3.9) 2.4
75–84 112 (1.1) 2.3 106 (3.7) 1.7 218 (1.6) 2.0
≥85 45 (<1.0) 2.7 54 (1.9) 1.8 99 (<1.0) 2.1
Unknown 3 (<1.0) —** 0 (0) 3 (<1.0)
Race/Ethnicity
White, non-Hispanic 2,489 (23.5) 3.3 1,317 (46.5) 1.7 3,806 (28.3) 2.5
Black, non-Hispanic 6,218 (58.6) 40.9 1,045 (36.9) 6.3 7,263 (54.0) 22.8
American Indian or Alaska Native, non-Hispanic 194 (1.8) 18.2 59 (2.1) 5.3 253 (1.9) 11.6
Asian or Pacific Islander, non-Hispanic 158 (1.5) 2.4 73 (2.6) 1.0 231 (1.7) 1.6
Hispanic†† 1,512 (14.3) 8.6 329 (11.6) 1.9 1,841 (13.7) 5.3
Other race or ethnicity 34 (<1.0) 6 (<1.0) 40 (<1.0)
Unknown 5 (<1.0) 2 (<1.0) 7 (<1.0)
Method
Firearm 8,035 (75.7) 6.9 1,569 (55.4) 1.3 9,604 (71.5) 4.1
Sharp instrument 983 (9.3) 0.9 438 (15.5) 0.4 1,421 (10.6) 0.6
Blunt instrument 373 (3.5) 0.3 197 (7.0) 0.2 570 (4.2) 0.2
Personal weapons (e.g., hands, feet, or fists) 366 (3.4) 0.3 139 (4.9) 0.1 505 (3.8) 0.2
Hanging, strangulation, or suffocation 120 (1.1) 0.1 188 (6.6) 0.2 308 (2.3) 0.1
Motor vehicle (e.g., bus, motorcycle, or other transport vehicle) 89 (<1.0) <0.1 36 (1.3) <0.1 125 (<1.0) <0.1
Fire or burns 35 (<1.0) <0.1 36 (1.3) <0.1 71 (<1.0) <0.1
Poisoning 42 (<1.0) <0.1 23 (<1.0) <0.1 65 (<1.0) <0.1
Intentional neglect 25 (<1.0) <0.1 26 (<1.0) <0.1 51 (<1.0) <0.1
Fall 30 (<1.0) <0.1 8 (<1.0) 38 (<1.0) <0.1
Shaking (e.g., shaken baby syndrome) 17 (<1.0) 12 (<1.0) 29 (<1.0) <0.1
Drowning 7 (<1.0) 8 (<1.0) 15 (<1.0)
Other (e.g., Taser, electrocution, or nail gun) 16 (<1.0) 10 (<1.0) 26 (<1.0)
Unknown 472 (4.4) 141 (5.0) 613 (4.6)
Location
House or apartment 4,177 (39.4) 3.6 1,837 (64.9) 1.5 6,014 (44.7) 2.6
Street or highway 2,606 (24.6) 2.3 238 (8.4) 0.2 2,844 (21.2) 1.2
Motor vehicle 1,092 (10.3) 0.9 216 (7.6) 0.2 1,308 (9.7) 0.6
Parking lot, public garage, or public transport 493 (4.6) 0.4 42 (1.5) <0.1 535 (4.0) 0.2
Commercial or retail area 413 (3.9) 0.4 57 (2.0) <0.1 470 (3.5) 0.2
Natural area 181 (1.7) 0.2 56 (2.0) <0.1 237 (1.8) 0.1
Park, playground, or sports or athletic area 154 (1.5) 0.1 26 (<1.0) <0.1 180 (1.3) <0.1
Bar or nightclub 156 (1.5) 0.1 5 (<1.0) 161 (1.2) <0.1
Hotel or motel 85 (<1.0) <0.1 47 (1.7) <0.1 132 (<1.0) <0.1
Jail or prison 89 (<1.0) <0.1 0 (0) 89 (<1.0) <0.1
Abandoned house, building, or warehouse 63 (<1.0) <0.1 16 (<1.0) 79 (<1.0) <0.1
Supervised residential facility 26 (<1.0) <0.1 19 (<1.0) 45 (<1.0) <0.1
Other location§§ 219 (2.1) 58 (2.0) 277 (2.1)
Unknown 856 (8.1) 214 (7.6) 1,070 (8.0)
Relationship of victim to suspect¶¶
Acquaintance or friend 1,220 (31.6) 1.1 217 (11.7) 0.2 1,437 (25.1) 0.6
Spouse or intimate partner (current or former) 321 (8.3) 0.3 942 (50.6) 0.8 1,263 (22.1) 0.5
Other person, known to victim 791 (20.5) 0.7 139 (7.5) 0.1 930 (16.2) 0.4
Stranger 646 (16.7) 0.6 108 (5.8) <0.1 754 (13.2) 0.3
Other relative 291 (7.5) 0.3 148 (7.9) 0.1 439 (7.7) 0.2
Child*** 222 (5.7) 0.2 150 (8.1) 0.1 372 (6.5) 0.2
Parent*** 173 (4.5) 0.2 117 (6.3) 0.1 290 (5.1) 0.1
Child of suspect's boyfriend or girlfriend (e.g., child killed by mother's boyfriend) 61 (1.6) <0.1 32 (1.7) <0.1 93 (1.6) <0.1
Rival gang member 71 (1.8) <0.1 6 (<1.0) 77 (1.3) <0.1
Other relationship+++ 67 (1.7) 3 (<1.0) 70 (1.2)
Total 10,610 (100.0) 9.2 2,831 (100.0) 2.4 13,441 (100.0) 5.7

Table 4. Number, percentage,* and rate of homicides, by selected demographic characteristics of decedent, method used, location in which injury occurred, and victim-suspect relationship§ — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

* Percentages might not total 100% due to rounding.
Per 100,000 population.
§ The following statement can be used as a general guide for interpreting the victim-suspect relationship: “The victim is the [insert relationship] of the suspect.” For example, when a parent kills a child, the relationship is “child,” not “parent” (The victim is the child of the suspect.). Some relationships might not be captured by this sentence (e.g., if the other person is known to the victim or if the victim was a law enforcement officer killed in the line of duty).
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
** Rates are not reported when the number of decedents is <20 or when the characteristic response is “other” or “unknown.”
†† Includes persons of any race.
§§ Other location includes (in descending order) office building; preschool, school, college, or school bus; synagogue, church, or temple; industrial or construction area; hospital or medical facility; farm; railroad tracks; cemetery, graveyard, or other burial ground; bridge; and other unspecified location.
¶¶ Percentage is based on the number of homicide decedents with a known victim-suspect relationship (n = 5,725 [42.6%]; 3,863 [36.4%] males and 1,862 [65.8%] females); victim-to-suspect relationship was unknown for 7,716 decedents.
*** Includes adoptive family members (e.g., adopted child), stepfamily members (e.g., stepparent), and foster family members (e.g., foster child).
††† Other relationship includes (in descending order) the victim was a law enforcement officer injured in the line of duty, and victim was an intimate partner of suspect's parent (e.g., teenager kills mother’s boyfriend).

Table 5.  

Precipitating circumstance Male Female Total
No. (%) No. (%) No. (%)
Mental health or substance use
Substance use problem (excludes alcohol) 998 (12.7) 288 (12.3) 1,286 (12.6)
Current diagnosed mental health problem 345 (4.4) 182 (7.7) 527 (5.2)
Alcohol problem 311 (4.0) 86 (3.7) 397 (3.9)
History of ever being treated for a mental health problem 219 (2.8) 119 (5.1) 338 (3.3)
Current mental health treatment 115 (1.5) 70 (3.0) 185 (1.8)
Current depressed mood 35 (<1.0) 26 (1.1) 61 (<1.0)
Other addiction (e.g., gambling or sex) 12 (<1.0) 4 (<1.0) 16 (<1.0)
Interpersonal
Intimate partner violence related 674 (8.6) 1,048 (44.6) 1,722 (16.9)
Family relationship problem 409 (5.2) 238 (10.1) 647 (6.3)
Other relationship problem (nonintimate) 482 (6.1) 107 (4.6) 589 (5.8)
Jealousy (lovers’ triangle) 202 (2.6) 108 (4.6) 310 (3.0)
Victim of interpersonal violence during past month 97 (1.2) 126 (5.4) 223 (2.2)
Perpetrator of interpersonal violence during past month 142 (1.8) 12 (<1.0) 154 (1.5)
Life stressor
Argument or conflict 2,752 (35.0) 693 (29.5) 3,445 (33.7)
Physical fight (two persons, not a brawl) 1,387 (17.6) 212 (9.0) 1,599 (15.7)
Crisis during previous or upcoming 2 weeks 433 (5.5) 222 (9.4) 655 (6.4)
History of child abuse or neglect 65 (<1.0) 41 (1.7) 106 (1.0)
Crime and criminal activity
Precipitated by another crime 2,195 (27.9) 477 (20.3) 2,672 (26.2)
      Crime in progress 1,326 (60.4) 276 (57.9) 1,602 (60.0)
Drug involvement 1,122 (14.3) 129 (5.5) 1,251 (12.3)
Gang-related 990 (12.6) 95 (4.0) 1,085 (10.6)
Homicide circumstance
Drive-by shooting 791 (10.1) 98 (4.2) 889 (8.7)
Walk-by assault 600 (7.6) 66 (2.8) 666 (6.5)
Victim used a weapon 612 (7.8) 29 (1.2) 641 (6.3)
Caretaker abuse or neglect led to death 261 (3.3) 198 (8.4) 459 (4.5)
Mentally ill suspect** 163 (2.1) 156 (6.6) 319 (3.1)
Justifiable self defense 283 (3.6) 7 (<1.0) 290 (2.8)
Random violence 169 (2.1) 63 (2.7) 232 (2.3)
Victim was a bystander 134 (1.7) 88 (3.7) 222 (2.2)
Brawl 191 (2.4) 10 (<1.0) 201 (2.0)
Victim was an intervener assisting a crime victim 100 (1.3) 21 (<1.0) 121 (1.2)
Prostitution 29 (<1.0) 28 (1.2) 57 (<1.0)
Stalking 20 (<1.0) 34 (1.4) 54 (<1.0)
Victim was a police officer on duty 39 (<1.0) 4 (<1.0) 43 (<1.0)
Mercy killing 5 (<1.0) 16 (<1.0) 21 (<1.0)
Hate crime 14 (<1.0) 7 (<1.0) 21 (<1.0)
Total†† 7,861 (74.1) 2,350 (83.0) 10,211 (76.0)

Table 5. Number* and percentage of homicides, by decedent’s sex and precipitating circumstance — National Violent Death Reporting System, 39 states and the district of Columbia, 2018§

* Includes homicides with one or more precipitating circumstances. Total numbers do not equal the sums of the columns because more than one circumstance could have been present per decedent.
Denominator includes those homicides with one or more precipitating circumstances. The sums of percentages in columns exceed 100% because more than one circumstance could have been present per decedent.
§ Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
Denominator includes those decedents involved in an incident that was precipitated by another crime.
** Mentally ill suspect is endorsed for deaths in which the suspect’s attack on decedent was believed to be the direct result of a mental health problem (e.g., schizophrenia or other psychotic condition, depression, or posttraumatic stress disorder).
†† Circumstances were unknown for 3,230 decedents (2,749 males and 481 females); total number of homicide decedents = 13,441 (10,610 males and 2,831 females).

Table 6.  

Characteristic Suspect age group (yrs) Total
<18 18–24 25–44 45–64 ≥65
No. (%)§ No. (%)§ No. (%)§ No. (%)§ No. (%)§ No. (%)§
Sex
Male 426 (91.0) 1,880 (88.8) 3,020 (86.5) 881 (85.0) 197 (90.4) 6,404 (87.4)
Female 37 (7.9) 226 (10.7) 461 (13.2) 154 (14.9) 21 (9.6) 899 (12.3)
Unknown 5 (1.1) 12 (<1.0) 9 (<1.0) 2 (<1.0) 0 (0) 28 (<1.0)
Race/Ethnicity
Black, non-Hispanic 290 (62.0) 1,303 (61.5) 1,798 (51.5) 373 (36.0) 35 (16.1) 3,799 (51.8)
White, non-Hispanic 87 (18.6) 407 (19.2) 1,021 (29.3) 518 (50.0) 149 (68.3) 2,182 (29.8)
Hispanic 37 (7.9) 189 (8.9) 322 (9.2) 63 (6.1) 9 (4.1) 620 (8.5)
Asian or Pacific Islander, non-Hispanic 0 (0.) 15 (<1.0) 35 (1.0) 18 (1.7) 5 (2.3) 73 (<1.0)
American Indian or Alaska Native, non-Hispanic 4 (<1.0) 12 (<1.0) 48 (1.4) 6 (<1.0) 2 (<1.0) 72 (<1.0)
Unknown 50 (10.7) 192 (9.1) 266 (7.6) 59 (5.7) 18 (8.3) 585 (8.0)
Relationship of victim to suspect**
Acquaintance or friend 98 (31.2) 447 (34.0) 666 (27.0) 192 (22.2) 21 (10.4) 1,424 (27.6)
Spouse or intimate partner (current or former) 8 (2.5) 124 (9.4) 521 (21.2) 333 (38.5) 114 (56.4) 1,100 (21.3)
Other person, known to victim 46 (14.6) 230 (17.5) 401 (16.3) 109 (12.6) 15 (7.4) 801 (15.5)
Stranger 77 (24.5) 232 (17.6) 333 (13.5) 65 (7.5) 10 (5.0) 717 (13.9)
Other relative†† 35 (11.1) 76 (5.8) 161 (6.5) 66 (7.6) 17 (8.4) 355 (6.9)
Child§§ 10 (3.2) 82 (6.2) 167 (6.8) 45 (5.2) 11 (5.4) 315 (6.1)
Parent§§ 24 (7.6) 48 (3.6) 107 (4.3) 48 (5.6) 8 (4.0) 235 (4.6)
Child of suspect's boyfriend or girlfriend (e.g., child killed by mother's boyfriend) 1 (<1.0) 24 (1.8) 56 (2.3) 4 (<1.0) 2 (<1.0) 87 (1.7)
Rival gang member 8 (2.5) 31 (2.4) 26 (1.1) 0 (0) 0 (0) 65 (1.3)
Intimate partner of suspect's parent (e.g., teenager kills mother’s boyfriend) 7 (2.2) 13 (<1.0) 9 (<1.0) 1 (<1.0) 1 (<1.0) 31 (<1.0)
Victim was a law enforcement officer on duty 0 (0) 9 (<1.0) 16 (<1.0) 1 (<1.0) 3 (1.5) 29 (<1.0)
Mental health or substance use¶¶
Suspected other substance use by suspect 27 (7.8) 119 (7.5) 297 (10.1) 76 (7.8) 4 (1.9) 523 (8.6)
Suspected alcohol use by suspect 14 (4.1) 77 (4.9) 239 (8.1) 112 (11.5) 11 (5.2) 453 (7.5)
Mentally ill suspect*** 9 (2.6) 47 (3.0) 144 (4.9) 69 (7.1) 21 (9.9) 290 (4.8)
Suspect had a developmental disability 1 (<1.0) 3 (<1.0) 5 (<1.0) 4 (<1.0) 1 (<1.0) 14 (<1.0)
Other circumstance of suspect†††
Prior contact with law enforcement 38 (11.0) 174 (11.0) 386 (13.1) 99 (10.1) 10 (4.7) 707 (11.6)
Suspect attempted suicide after incident§§§ 6 (1.7) 30 (1.9) 192 (6.5) 171 (17.5) 82 (38.5) 481 (7.9)
Suspect recently released from an institution 3 (<1.0) 38 (2.4) 69 (2.3) 21 (2.1) 4 (1.9) 135 (2.2)
Homicide circumstance
Precipitated by another crime 114 (38.9) 463 (32.8) 733 (27.5) 202 (22.0) 30 (14.9) 1,542 (28.1)
Intimate partner violence related 25 (8.5) 171 (12.1) 680 (25.5) 388 (42.3) 117 (58.2) 1,381 (25.1)
Drug involvement 58 (19.8) 228 (16.1) 340 (12.7) 53 (5.8) 4 (2.0) 683 (12.4)
Victim used a weapon 27 (9.2) 122 (8.6) 202 (7.6) 57 (6.2) 10 (5.0) 418 (7.6)
Gang related 29 (9.9) 157 (11.1) 193 (7.2) 9 (<1.0) 0 (0) 388 (7.1)
Drive by shooting 20 (6.8) 114 (8.1) 126 (4.7) 9 (<1.0) 0 (0) 269 (4.9)
Jealousy (lovers’ triangle) 5 (1.7) 47 (3.3) 139 (5.2) 54 (5.9) 4 (2.0) 249 (4.5)
Brawl (mutual physical fight) 10 (3.4) 40 (2.8) 58 (2.2) 6 (<1.0) 0 (0) 114 (2.1)
Random violence 8 (2.7) 33 (2.3) 54 (2.0) 11 (1.2) 2 (<1.0) 108 (2.0)
Victim was a bystander 10 (3.4) 38 (2.7) 40 (1.5) 6 (<1.0) 0 (0) 94 (1.7)
Stalking 0 (0) 6 (<1.0) 21 (<1.0) 12 (1.3) 3 (1.5) 42 (<1.0)
Prostitution 1 (<1.0) 9 (<1.0) 24 (<1.0) 4 (<1.0) 0 (0) 38 (<1.0)
Hate crime 0 (0) 3 (<1.0) 2 (<1.0) 2 (<1.0) 0 (0) 7 (<1.0)
Total 468 2,118 3,490 1,037 218 7,331

Table 6. Number and percentage* of homicides, by selected demographic characteristics of suspect, victim-suspect relationship, suspect’s mental health or substance use, and homicide circumstance — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

* Percentages might not total 100% due to rounding. There were 12,693 homicide incidents overall and 9,331 suspects from 8,051 incidents with suspect information. Of the total number of homicide incidents, 6,071 (47.8%) had known suspect age, resulting in 7,331 suspects (age was unknown for n = 2,600 (26.2%) of suspects). Some incidents had >1 suspect. Denominators for suspect characteristics and circumstances vary by the availability of known information and are specified in separate footnotes.
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
§Percentage is based on the total number of suspects within each age group (i.e., column totals at the bottom of the table).
Includes persons of any race.
** Percentage is based on the number of homicide suspects with a known age and victim-suspect relationship (n = 5,159; aged <18 years = 314; aged 18–24 years = 1,316; aged 25–44 years = 2,463; aged 45–64 years = 864; aged ≥65 years = 202); victim-suspect relationship was unknown for 2,172 suspects. The victim-suspect relationship should be interpreted using the following statement: “The victim is the [insert relationship] of the suspect,” with the exception of the caregiver relationship.
†† Other relative includes other family member (e.g., cousin or uncle), sibling, grandparent, in-law, or grandchild.
§§ Includes adoptive family members (e.g., adopted child), stepfamily members (e.g., stepparent), and foster family members (e.g., foster child).
¶¶ Percentage is based on the number of homicide incidents (n = 6,071; aged <18 years = 344; aged 18–24 years = 1,586; aged 25–44 years = 2,951; aged 45–64 years = 977; and aged ≥65 years = 213) with the count representing the total number of suspects having that characteristic.
*** Mentally ill suspect is endorsed for deaths in which the suspect’s attack on decedent was believed to be the direct result of a mental health problem (e.g., schizophrenia or other psychotic condition, depression, or posttraumatic stress disorder).
††† Percentage is based on the number of homicide incidents with known suspect age and decedent circumstances (n = 5,494; primary suspect: aged <18 years = 293; aged 18–24 years = 1,412; aged 25–44 years = 2,670; aged 45–64 years = 918; and aged ≥65 years = 201). The characteristic applies to one or more decedents in the incident.
§§§ Number and percentage of suspect suicide attempts that were fatal, based on the number who attempted suicide: n = 389 (80.9%); aged <18 years = 5 (83.3%); aged 18–24 years = 18 (60.0%); aged 25–44 years = 151 (78.6%); aged 45–64 years = 138 (80.7%); and aged ≥65 years = 77 (93.9%).

Table 7.  

Characteristic Male Female Total
No. (%) Rate No. (%) Rate No. (%) Rate
Age group (yrs)
<10 0 (0) —** 0 (0) 0 (0)
10–14 1 (<1.0) 0 (0) 1 (<1.0)
15–19 39 (5.4) 0.5 1 (2.7) 40 (5.2) 0.3
20–24 84 (11.6) 1.0 2 (5.4) 86 (11.3) 0.5
25–29 113 (15.5) 1.3 5 (13.5) 118 (15.4) 0.7
30–34 118 (16.2) 1.5 7 (18.9) 125 (16.4) 0.8
35–44 190 (26.1) 1.3 10 (27.0) 200 (26.2) 0.7
45–54 96 (13.2) 0.7 7 (18.9) 103 (13.5) 0.3
55–64 58 (8.0) 0.4 3 (8.1) 61 (8.0) 0.2
65–74 22 (3.0) 0.2 2 (5.4) 24 (3.1) 0.1
75–84 6 (<1.0) 0 (0) 6 (<1.0)
≥85 0 (0) 0 (0) 0 (0)
Race/Ethnicity
White, non-Hispanic 354 (48.7) 0.5 21 (56.8) <0.1 375 (49.1) 0.3
Black, non-Hispanic 190 (26.1) 1.3 9 (24.3) 199 (26.0) 0.6
American Indian or Alaska Native, non-Hispanic 28 (3.9) 2.6 1 (2.7) 29 (3.8) 1.3
Asian or Pacific Islander, non-Hispanic 13 (1.8) 0 (0) 13 (1.7)
Hispanic†† 138 (19.0) 0.8 6 (16.2) 144 (18.8) 0.4
Other race or ethnicity 4 (<1.0) 0 (0) 4 (<1.0)
Method
Firearm 659 (90.6) 0.6 29 (78.4) <0.1 688 (90.1) 0.3
Motor vehicles (e.g., buses, motorcycles, other transport vehicles) 22 (3.0) <0.1 6 (16.2) 28 (3.7) <0.1
Personal weapons (e.g., hands, feet, or fists) 8 (1.1) 0 (0) 8 (1.0)
Poisoning 6 (<1.0) 0 (0) 6 (<1.0)
Hanging, strangulation, or suffocation 6 (<1.0) 0 (0) 6 (<1.0)
Blunt instrument 3 (<1.0) 0 (0) 3 (<1.0)
Drowning 2 (<1.0) 0 (0) 2 (<1.0)
Other (e.g., Taser, electrocution, or nail gun) 12 (1.7) 0 (0) 12 (1.6)
Unknown 9 (1.2) 2 (5.4) 11 (1.4)
Location of injury
House or apartment 259 (35.6) 0.2 13 (35.1) 272 (35.6) 0.1
Street or highway 188 (25.9) 0.2 8 (21.6) 196 (25.7) <0.1
Motor vehicle 73 (10.0) <0.1 8 (21.6) 81 (10.6) <0.1
Parking lot, public garage, or public transport 47 (6.5) <0.1 3 (8.1) 50 (6.5) <0.1
Commercial or retail area 36 (5.0) <0.1 1 (2.7) 37 (4.8) <0.1
Natural area 22 (3.0) <0.1 0 (0) 22 (2.9) <0.1
Hotel or motel 16 (2.2) 0 (0) 16 (2.1)
Park, playground, or sports or athletic area 10 (1.4) 0 (0) 10 (1.3)
Jail or prison 10 (1.4) 0 (0) 10 (1.3)
Other location§§ 44 (6.1) 1 (2.7) 45 (5.9)
Unknown 22 (3.0) 3 (8.1) 25 (3.3)
Total 727 (100.0) 0.6 37 (100.0) <0.1 764 (100.0) 0.3

Table 7. Number, percentage,* and rate of legal intervention§ deaths, by selected demographic characteristics of decedent, method used, and location in which injury occurred — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

* Percentages might not total 100% due to rounding.
Per 100,000 population.
§ The term legal intervention does not denote the lawfulness or legality of the circumstances surrounding the death.
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
** Rates are not reported when number of decedents is <20 or when characteristic response is “other” or “unknown.”
†† Includes persons of any race.
§§ Other location includes (in descending order) office building; bar or nightclub; hospital or medical facility; farm; preschool, school, college, or school bus; abandoned house, building, or warehouse; synagogue, church, or temple; industrial or construction area; supervised residential facility; bridge; and other unspecified location.

Table 8.  

Precipitating circumstance Male Female Total
No. (%) No. (%) No. (%)
Mental health or substance use
Substance use problem (excludes alcohol) 194 (27.6) 9 (28.1) 203 (27.7)
Current diagnosed mental health problem 133 (18.9) 8 (25.0) 141 (19.2)
History of ever being treated for a mental health problem 81 (11.5) 5 (15.6) 86 (11.7)
Alcohol problem 74 (10.5) 2 (6.3) 76 (10.4)
Current mental health treatment 42 (6.0) 3 (9.4) 45 (6.1)
Current depressed mood 36 (5.1) 0 (0) 36 (4.9)
Other addiction (e.g., gambling or sex) 3 (<1.0) 0 (0) 3 (<1.0)
Interpersonal
Intimate partner violence-related 75 (10.7) 1 (3.1) 76 (10.4)
Perpetrator of interpersonal violence during past month 63 (9.0) 0 (0) 63 (8.6)
Family relationship problem 62 (8.8) 0 (0) 62 (8.4)
Other relationship problem (nonintimate) 23 (3.3) 0 (0) 23 (3.1)
Jealousy (lovers’ triangle) 7 (<1.0) 0 (0) 7 (<1.0)
Victim of interpersonal violence during past month 2 (<1.0) 0 (0) 2 (<1.0)
Life stressor
Argument or conflict 112 (16.0) 4 (12.5) 116 (15.8)
Crisis during previous or upcoming 2 weeks 87 (12.4) 1 (3.1) 88 (12.0)
Physical fight (two persons, not a brawl) 64 (9.1) 1 (3.1) 65 (8.9)
History of child abuse or neglect 4 (<1.0) 0 (0) 4 (<1.0)
Crime and criminal activity
Precipitated by another crime 606 (86.3) 27 (84.4) 633 (86.2)
      Crime in progress** 438 (72.3) 19 (70.4) 457 (72.2)
Drug involvement 37 (5.3) 3 (9.4) 40 (5.4)
Gang related 12 (1.7) 0 (0) 12 (1.6)
Legal intervention
Victim used a weapon 518 (73.8) 21 (65.6) 539 (73.4)
Brawl 12 (1.7) 0 (0) 12 (1.6)
Victim was a bystander 1 (<1.0) 3 (9.4) 4 (<1.0)
Random violence 3 (<1.0) 0 (0) 3 (<1.0)
Stalking 3 (<1.0) 0 (0) 3 (<1.0)
Victim was an intervener assisting a crime victim 2 (<1.0) 0 (0) 2 (<1.0)
Caretaker abuse or neglect led to death 1 (<1.0) 0 (0) 1 (<1.0)
Prostitution 0 (0) 1 (3.1) 1 (<1.0)
Total†† 702 (96.6) 32 (86.5) 734 (96.1)

Table 8. Number* and percentage of legal intervention§ deaths, by decedent’s sex and precipitating circumstance — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

* Includes deaths with one or more precipitating circumstances. Total numbers do not equal the sums of the columns because more than one circumstance could have been present per decedent.
Denominator includes those deaths with one or more precipitating circumstances. The sums of percentages in columns exceed 100% because more than one circumstance could have been present per decedent.
§ The term legal intervention does not denote the lawfulness or legality of the circumstances surrounding the death.
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
** Denominator includes those decedents involved in an incident that was precipitated by another crime.
†† Circumstances were unknown for 30 decedents (25 males and five females); total number of legal intervention deaths = 764 (727 males and 37 females).

Table 9.  

Characteristic No. (%)
Age group (yrs)
18–24 6 (1.1)
25–44 145 (26.5)
45–64 34 (6.2)
≥65 0 (0)
Unknown 362 (66.2)
Race/Ethnicity
White, non-Hispanic 207 (37.8)
Black, non-Hispanic 16 (2.9)
American Indian or Alaska Native, non-Hispanic 0 (0)
Asian or Pacific Islander, non-Hispanic 0 (0)
Hispanic§ 17 (3.1)
Unknown 307 (56.1)
Total 547 (100.0)

Table 9. Number and percentage* of law enforcement officers involved in legal intervention deaths, by age group and race and ethnicity — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

* Percentages might not total 100% due to rounding. There were 757 legal intervention incidents. Percentage is based on the number of law enforcement officers (n = 547; male, n= 527; female, n = 13; sex unknown, n = 7) from legal intervention incidents with any information about the officer involved (n = 383; 50.6%). Of officers with known sex, 96.3% were male. Some incidents had more than one suspect.
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
§ Includes persons of any race.

Table 10.  

Characteristic No. (%)
Sex
Male 297 (88.1)
Female 40 (11.9)
Race/Ethnicity
White, non-Hispanic 192 (57.0)
Black, non-Hispanic 109 (32.3)
American Indian or Alaska Native, non-Hispanic 7 (2.1)
Asian or Pacific Islander, non-Hispanic 3 (<1.0)
Hispanic§ 26 (7.7)
Age group (yrs)
<1 0 (0)
1–4 24 (7.1)
5–9 16 (4.7)
10–14 27 (8.0)
15–19 68 (20.2)
20–24 49 (14.5)
25–29 24 (7.1)
30–34 22 (6.5)
35–44 22 (6.5)
45–54 21 (6.2)
55–64 29 (8.6)
65–74 21 (6.2)
75–84 12 (3.6)
≥85 2 (<1.0)
Location
House or apartment 256 (76.0)
Natural area 23 (6.8)
Motor vehicle 17 (5.0)
Street or highway 7 (2.1)
Hotel or motel 6 (1.8)
Commercial or retail area 3 (<1.0)
Parking lot, public garage, or public transport 3 (<1.0)
Other location 11 (3.3)
Unknown 11 (3.3)
Firearm type
Handgun 208 (61.7)
Rifle 44 (13.1)
Shotgun 30 (8.9)
Other firearm 1 (<1.0)
Unknown 54 (16.0)
Total 337 (100.0)

Table 10. Number and percentage* of unintentional firearm deaths, by selected demographic characteristic of decedent, location of injury, and type of firearm — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

* Percentages might not total 100% due to rounding.
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
§ Includes persons of any race.
Other location includes (in descending order) bar or nightclub; office building; park, playground, or sports or athletic area; farm; and other unspecified location.

Table 11.  

Characteristic No. (%)
Context of injury
Playing with gun 124 (41.6)
Showing gun to others 46 (15.4)
Cleaning gun 26 (8.7)
Hunting 21 (7.0)
Loading or unloading gun 13 (4.4)
Target shooting 8 (2.7)
Celebratory firing 1 (<1.0)
Other context of injury 72 (24.2)
Circumstance of injury
Unintentionally pulled trigger 66 (22.1)
Thought gun was unloaded 35 (11.7)
Thought unloaded, magazine disengaged 20 (6.7)
Gun was dropped 18 (6.0)
Gun was mistaken for a toy 9 (3.0)
Thought gun safety was engaged 8 (2.7)
Gun fired due to defect or malfunction 6 (2.0)
Bullet ricocheted 3 (1.0)
Gun fired while handling safety lock 2 (<1.0)
Other mechanism of injury 52 (17.4)
Total§ 298 (88.4)

Table 11. Number and percentage* of unintentional firearm deaths, by context and circumstance of injury — National Violent Death Reporting System, 39 states and the District of Columbia, 2018

* Percentages might exceed 100% because one or more circumstances could have been known per death. Number and percentage are reported when the number of deaths is fewer than five because no particular circumstance identifies a single death. Denominator includes those deaths with one or more precipitating circumstances.
Data for all violent deaths were collected in 36 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), and the District of Columbia. Three states (California, Illinois, and Pennsylvania) collected data from a subset of counties in their state. Data for violent deaths that occurred in Illinois include 28 counties that represent 86% of the state’s population (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). Data for violent deaths that occurred in Pennsylvania include 39 counties that represent 82.2% of the state’s population (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). Data for violent deaths that occurred in California include 21 counties that represent 54% of the state’s population (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Diego, San Francisco, San Mateo, Shasta, Siskiyou, Ventura, and Yolo). Denominators for the rates for these three states (California, Illinois, and Pennsylvania) represent only the populations of the counties from which the data were collected.
§ Circumstances were unknown for 39 decedents; total number of unintentional firearm decedents = 337.

Table 12.  

Manner of death Death ≤1 year after injury Death >1 year after injury Death any time after injury
Intentional self-harm (suicide) X60–X84 Y87.0 U03 (attributable to terrorism)
Assault (homicide) X85–X99, Y00–Y09 Y87.1 U01, U02 (attributable to terrorism)
Event of undetermined intent Y10–Y34 Y87.2, Y89.9 Not applicable
Unintentional exposure to inanimate mechanical forces (firearms) W32–W34 Y86 Not applicable
Legal intervention (excluding executions, Y35.5) Y35.0–Y35.4, Y35.6, Y35.7 Y89.0 Not applicable

Box 1. International Classification of Diseases, Tenth Revision (ICD-10) codes used in the National Violent Death Reporting System

Table 13.  

• Firearm: method that uses a powder charge to fire a projectile from the weapon (excludes BB gun, pellet gun, and compressed air or gas-powered gun)

• Hanging, strangulation, or suffocation (e.g., hanging by the neck, manual strangulation, or plastic bag over the head)

• Poisoning (e.g., fatal ingestion of a street drug, pharmaceutical, carbon monoxide, gas, rat poison, or insecticide)

• Sharp instrument (e.g., knife, razor, machete, or pointed instrument)

• Blunt instrument (e.g., club, bat, rock, or brick)

• Fall: being pushed or jumping

• Motor vehicle (e.g., car, bus, motorcycle, or other transport vehicle)

• Personal weapons (e.g., hands, fists, or feet)

• Drowning: inhalation of liquid (e.g., in bathtub, lake, or other source of water or liquid)

• Fire or burns: inhalation of smoke or the direct effects of fire or chemical burns

• Intentional neglect: starvation, lack of adequate supervision, or withholding of health care

• Other (single method): any method other than those already listed (e.g., electrocution, exposure to environment or weather, or explosives)

• Unknown: method not reported or not known

Box 2. Methods used to inflict injury — National Violent Death Reporting System, 2018

Table 14.  

Suicide/Undetermined Intent

• Intimate partner problem: decedent was experiencing problems with a current or former intimate partner.

• Suicide of family member or friend: decedent was distraught over, or reacting to, the recent suicide of a family member or friend.

• Other death of family member or friend: decedent was distraught over, or reacting to, the recent nonsuicide death of a family member or friend.

• Physical health problem: decedent was experiencing physical health problems (e.g., a recent cancer diagnosis or chronic pain).

• Job problem: decedent was either experiencing a problem at work or was having a problem with joblessness.

• Recent criminal legal problem: decedent was facing criminal legal problems (e.g., recent or impending arrest or upcoming criminal court date).

• Noncriminal legal problem: decedent was facing civil legal problems (e.g., a child custody or civil lawsuit).

• Financial problem: decedent was experiencing financial problems (e.g., bankruptcy, overwhelming debt, or foreclosure of a home or business).

• Eviction or loss of home: decedent was experiencing a recent or impending eviction or other loss of housing, or the threat of eviction or loss of housing.

• School problem: decedent was experiencing a problem related to school (e.g., poor grades, bullying, social exclusion at school, or performance pressures).

• Traumatic anniversary: the incident occurred on or near the anniversary of a traumatic event in the decedent’s life.

• Exposure to disaster: decedent was exposed to a disaster (e.g., earthquake or bombing).

• Left a suicide note: decedent left a note, e-mail message, video, or other communication indicating intent to die by suicide.

• Disclosed suicidal intent: decedent had recently expressed suicidal feelings to another person with time for that person to intervene.

• Disclosed intent to whom: type of person (e.g., family member or current or former intimate partner) to whom the decedent recently disclosed suicidal thoughts or plans.

• History of suicidal thoughts or plans: decedent had previously expressed suicidal thoughts or plans.

• History of suicide attempt: decedent had previously attempted suicide before the fatal incident.

Homicide/Legal Intervention

• Jealousy (lovers’ triangle): jealousy or distress over an intimate partner’s relationship or suspected relationship with another person.

• Stalking: pattern of unwanted harassing or threatening tactics by either the decedent or suspect.

• Prostitution: prostitution or related activity that includes prostitutes, pimps, clients, or others involved in such activity.

• Drug involvement: drug dealing, drug trade, or illicit drug use that is suspected to have played a role in precipitating the incident.

• Brawl: mutual physical fight involving three or more persons.

• Mercy killing: decedent wished to die because of a terminal or hopeless disease or condition, and documentation indicates that the decedent wanted to be killed.

• Victim was a bystander: decedent was not the intended target in the incident (e.g., pedestrian walking past a gang fight).

• Victim was a police officer on duty: decedent was a law enforcement officer killed in the line of duty.

• Victim was an intervener assisting a crime victim: decedent was attempting to assist a crime victim at the time of the incident (e.g., a child attempts to intervene and is killed while trying to assist a parent who is being assaulted).

• Victim used a weapon: decedent used a weapon to attack or defend during the course of the incident.

• Intimate partner violence related: incident is related to conflict between current or former intimate partners; includes the death of an intimate partner or nonintimate partner (e.g., child, parent, friend, or law enforcement officer) killed in an incident that originated in a conflict between intimate partners.

• Hate crime: decedent was selected intentionally because of his or her actual or perceived gender, religion, sexual orientation, race, ethnicity, or disability.

• Mentally ill suspect: suspect’s attack on decedent was believed to be the direct result of a mental health problem (e.g., schizophrenia or other psychotic condition, depression, or PTSD).

• Drive-by shooting: suspect drove near the decedent and fired a weapon while driving.

• Walk-by assault: decedent was killed by a targeted attack (e.g., ambush) where the suspect fled on foot.

• Random violence: decedent was killed in a random act of violence (i.e., an act in which the suspect is not concerned with who is being harmed, just that someone is being harmed).

• Gang related: incident resulted from gang activity or gang rivalry; not used if the decedent was a gang member and the death did not appear to result from gang activity.

• Justifiable self-defense: decedent was killed by a law enforcement officer in the line of duty or by a civilian in legitimate self-defense or in defense of others.

• Intimate partner violence related: incident is related to conflict between current or former intimate partners; includes the death of an intimate partner or nonintimate partner (e.g., child, parent, friend, or law enforcement officer) killed in an incident that originated in a conflict between intimate partners.

Suspect Information

• Suspected other substance use by suspect: suspected substance use by the suspect in the hours preceding the incident.

• Suspected alcohol use by suspect: suspected alcohol use by the suspect in the hours preceding the incident.

• Suspect had developmental disability: suspect had developmental disability at time of incident.

• Mentally ill suspect: suspect’s attack on decedent was believed to be the direct result of a mental health problem (e.g., schizophrenia or other psychotic condition, depression, or PTSD).

• Prior contact with law enforcement: suspect had contact with law enforcement in the past 12 months.

• Suspect attempted suicide after incident: suspect attempted suicide (fatally or nonfatally) after the death of the victim.

• Suspect recently released from an institution: suspect injured victim within a month of being released from or admitted to an institutional setting (e.g., jail, hospital, psychiatric hospital).

All Manners of Death (Except Unintentional Firearm

• Current depressed mood: decedent was perceived by self or others to be feeling depressed at the time of death.

• Current diagnosed mental health problem: decedent was identified as having a mental health disorder or syndrome listed in the Diagnostic and Statistical Manual, Version V (DSM-V), with the exception of alcohol and other substance dependence (these are captured in separate variables).

• Type of mental health diagnosis: identifies the type of DSM-V diagnosis reported for the decedent.

• Current mental health treatment: decedent was receiving mental health treatment as evidenced by a current prescription for a psychotropic medication, visit or visits to a mental health professional, or participation in a therapy group within the previous 2 months.

• History of ever being treated for mental health problem: decedent was identified as having ever received mental health treatment.

• Alcohol problem: decedent was perceived by self or others to have a problem with, or to be addicted to, alcohol.

• Substance use problem (excludes alcohol): decedent was perceived by self or others to have a problem with, or be addicted to, a substance other than alcohol.

• Other addiction: decedent was perceived by self or others to have an addiction other than to alcohol or other substance (e.g., gambling or sex).

• Family relationship problem: decedent was experiencing problems with a family member, other than an intimate partner.

• Other relationship problem (nonintimate): decedent was experiencing problems with a friend or associate (other than an intimate partner or family member).

• History of child abuse or neglect: as a child, decedent had history of physical, sexual, or psychological abuse; physical (including medical or dental), emotional, or educational neglect; exposure to a violent environment, or inadequate supervision by a caretaker.

• Caretaker abuse or neglect led to death: decedent was experiencing physical, sexual, or psychological abuse; physical (including medical or dental), emotional, or educational neglect; exposure to a violent environment; or inadequate supervision by a caretaker that led to death.

• Perpetrator of interpersonal violence during previous month: decedent perpetrated interpersonal violence during the previous month.

• Victim of interpersonal violence during previous month: decedent was the target of interpersonal violence during the past month.

• Physical fight (two persons, not a brawl): a physical fight between two individuals that resulted in the death of the decedent, who was either involved in the fight, a bystander, or trying to stop the fight.

• Argument or conflict: a specific argument or disagreement led to the victim’s death.

• Precipitated by another crime: incident occurred as the result of another serious crime.

• Nature of crime: the specific type of other crime that occurred during the incident (e.g., robbery or drug trafficking).

• Crime in progress: another serious crime was in progress at the time of the incident.

• Terrorist attack: decedent was injured in a terrorist attack, leading to death.

• Crisis during previous or upcoming 2 weeks: current crisis or acute precipitating event or events that either occurred during the previous 2 weeks or was impending in the following 2 weeks (e.g., a trial for a criminal offense begins the following week) and appeared to have contributed to the death. Crises typically are associated with specific circumstance variables (e.g., job problem was a crisis, or a financial problem was a crisis).

• Other crisis: a crisis related to a death but not captured by any of the standard circumstances.

Unintentional Firearm Death
Context of Injury

• Hunting: death occurred any time after leaving home for a hunting trip and before returning home from a hunting trip.

• Target shooting: shooter was aiming for a target and unintentionally hit the decedent; can be at a shooting range or an informal backyard setting (e.g., teenagers shooting at signposts on a fence).

• Loading or unloading gun: gun discharged when the shooter was loading or unloading ammunition.

• Cleaning gun: shooter pulled trigger or gun discharged while cleaning, repairing, assembling, or disassembling gun.

• Showing gun to others: gun was being shown to another person when it discharged, or the trigger was pulled.

• Playing with gun: shooter was playing with a gun when it discharged.

• Celebratory firing: shooter fired gun in celebratory manner (e.g., firing into the air at midnight on New Year’s Eve).

• Other context of injury: shooting occurred during some context other than those already described.

    Mechanism of Injury

    • Unintentionally pulled trigger: shooter unintentionally pulled the trigger (e.g., while grabbing the gun or holding it too tightly).

    • Thought gun safety was engaged: shooter thought the safety was on and gun would not discharge.

    • Thought unloaded or magazine disengaged: shooter thought the gun was unloaded because the magazine was disengaged.

    • Thought gun was unloaded: shooter thought the gun was unloaded for other unspecified reason.

    • Bullet ricocheted: bullet ricocheted from its intended target and struck the decedent.

    • Gun fired due to defect or malfunction: gun had a defect or malfunctioned as determined by a trained firearm examiner.

    • Gun fired while holstering: gun was being replaced or removed from holster or clothing.

    • Gun was dropped: gun discharged when it was dropped.

    • Gun fired while operating safety or lock: shooter unintentionally fired the gun while operating the safety or lock.

    • Gun was mistaken for toy: gun was mistaken for a toy and was fired without the user understanding the danger.

    • Other mechanism of injury: shooting occurred as the result of a mechanism not already described.

    Box 3. Circumstances preceding fatal injury, by manner of death — National Violent Death Reporting System, 2018

    CME / ABIM MOC / CE

    Surveillance for Violent Deaths — National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018

    • Authors: Kameron J. Sheats, PhD; Rebecca F. Wilson, PhD; Bridget H. Lyons, MPH; Shane P.D. Jack, PhD; Carter J. Betz, MS; Katherine A. Fowler, PhD
    • CME / ABIM MOC / CE Released: 5/16/2022
    • Valid for credit through: 5/16/2023
    Start Activity

    • Credits Available

      Physicians - maximum of 3.00 AMA PRA Category 1 Credit(s)™

      ABIM Diplomates - maximum of 3.00 ABIM MOC points

      Nurses - 3.00 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

      Pharmacists - 3.00 Knowledge-based ACPE (0.300 CEUs)

      You Are Eligible For

      • Letter of Completion
      • ABIM MOC points

    Target Audience and Goal Statement

    This activity is intended for public health officials, trauma clinicians, emergency clinicians, psychiatrists, nurses, pharmacists, and other clinicians caring for patients with or at risk for violent injury.

    The goal of this activity is for the learner to better be able to describe data from the Center for Disease Control and Prevention (CDC) National Violent Death Reporting System (NVDRS) on violent deaths in 2018 in 39 states, District of Columbia, and Puerto Rico, by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics.

    Upon completion of this activity, participants will:

    1. Describe National Violent Death Reporting System (NVDRS) data on violent deaths in 2018 in 39 states, the District of Columbia, and Puerto Rico, by manner of death, sex, age group, and race/ethnicity
    2. Describe NVDRS data on violent deaths in 2018 in 39 states, the District of Columbia, and Puerto Rico, by method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics
    3. Highlight public health implications of NVDRS data on violent deaths in 2018 in 39 states, the District of Columbia, and Puerto Rico


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    Faculty

    • Kameron J. Sheats, PhD

      Division of Violence Prevention
      National Center for Injury Prevention and Control
      Centers for Disease Control and Prevention (CDC)
      Atlanta, Georgia

      Disclosures

      Disclosure: Kameron J. Sheats, PhD, has disclosed no relevant financial relationships.

    • Rebecca F. Wilson, PhD

      Division of Violence Prevention
      National Center for Injury Prevention and Control
      Centers for Disease Control and Prevention (CDC)
      Atlanta, Georgia

      Disclosures

      Disclosure: Rebecca F. Wilson, PhD, has disclosed no relevant financial relationships.

    • Bridget H. Lyons, MPH

      Division of Violence Prevention
      National Center for Injury Prevention and Control
      Centers for Disease Control and Prevention (CDC)
      Atlanta, Georgia

      Disclosures

      Disclosure: Bridget H. Lyons, MPH, has disclosed no relevant financial relationships.

    • Shane P.D. Jack, PhD

      Division of Violence Prevention
      National Center for Injury Prevention and Control
      Centers for Disease Control and Prevention (CDC)
      Atlanta, Georgia

      Disclosures

      Disclosure: Shane P.D. Jack, PhD, has disclosed no relevant financial relationships.

    • Carter J. Betz, MS

      Division of Violence Prevention
      National Center for Injury Prevention and Control
      Centers for Disease Control and Prevention (CDC)
      Atlanta, Georgia

      Disclosures

      Disclosure: Carter J. Betz, MS, has disclosed no relevant financial relationships.

    • Katherine A. Fowler, PhD

      Division of Violence Prevention
      National Center for Injury Prevention and Control
      Centers for Disease Control and Prevention (CDC)
      Atlanta, Georgia

      Disclosures

      Disclosure: Katherine A. Fowler, PhD, has disclosed no relevant financial relationships.

    CME Author

    • Laurie Barclay, MD

      Freelance writer and reviewer
      Medscape, LLC

      Disclosures

      Disclosure: Laurie Barclay, MD, has disclosed the following relevant financial relationships:
      Stocks, stock options, or bonds: AbbVie Inc. (former)

    Compliance Reviewer/Nurse Planner

    • Lisa Simani, APRN, MS, ACNP

      Associate Director, Accreditation and Compliance
      Medscape, LLC

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      Disclosure: Lisa Simani, APRN, MS, ACNP, has disclosed no relevant financial relationships.


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    CME / ABIM MOC / CE

    Surveillance for Violent Deaths — National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018

    Authors: Kameron J. Sheats, PhD; Rebecca F. Wilson, PhD; Bridget H. Lyons, MPH; Shane P.D. Jack, PhD; Carter J. Betz, MS; Katherine A. Fowler, PhDFaculty and Disclosures

    CME / ABIM MOC / CE Released: 5/16/2022

    Valid for credit through: 5/16/2023

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    Abstract and Introduction

    Abstract

    Problem/Condition: In 2018, approximately 68,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC’s National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 39 states the District of Columbia, and Puerto Rico in 2018. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics.

    Period Covered: 2018.

    Description of System: NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner reports, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2018. Data were collected from 36 states with statewide data (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin), three states with data from counties representing a subset of their population (21 California counties, 28 Illinois counties, and 39 Pennsylvania counties), the District of Columbia, and Puerto Rico. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident.

    Results: For 2018, NVDRS collected information on 52,773 fatal incidents involving 54,170 deaths that occurred in 39 states and the District of Columbia. In addition, information was collected on 880 fatal incidents involving 975 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 54,170 deaths, the majority (64.1%) were suicides, followed by homicides (24.8%), deaths of undetermined intent (9.0%), legal intervention deaths (1.4%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm deaths (<1.0%). (The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Demographic patterns and circumstances varied by manner of death. The suicide rate was higher among males than among females and was highest among adults aged 35–64 years and non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White persons. The most common method of injury for suicide was a firearm among males and hanging, strangulation, or suffocation among females. Suicide was most often preceded by a mental health, intimate partner, or physical health problem, or a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was highest among persons aged 20–24 years and was higher among males than females. Non-Hispanic Black males experienced the highest homicide rate of any racial or ethnic group. The most common method of injury for homicide was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicides most often were precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, were related to intimate partner violence. Homicide suspects were primarily male and the highest proportion were aged 25–44 years. When race and ethnicity information was known, non-Hispanic Black persons comprised the largest group of suspects overall and among those aged ≤44 years, and non-Hispanic White persons comprised the largest group of suspects among those aged ≥45 years. Almost all legal intervention deaths were experienced by males, and the legal intervention death rate was highest among males aged 30–34 years. Non-Hispanic AI/AN males had the highest legal intervention death rate, followed by non-Hispanic Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. The most frequent circumstances reported for legal intervention deaths were use of a weapon by the victim in the incident and a mental health or perceived substance use problem (other than alcohol use). Law enforcement officers who inflicted fatal injuries in the context of legal intervention deaths were primarily males aged 25–44 years. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White persons, and persons aged 15–24 years. These deaths most often occurred while the shooter was playing with a firearm and most frequently were precipitated by a person unintentionally pulling the trigger or mistakenly thinking that the firearm was unloaded. The rate of deaths of undetermined intent was highest among males, particularly among non-Hispanic Black and non-Hispanic AI/AN males, and among persons aged 45–54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in approximately 80% of decedents tested for those substances.

    Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2018. The suicide rate was highest among non-Hispanic AI/AN and non-Hispanic White males, and the homicide rate was highest among non-Hispanic Black males. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Circumstances for suspects of homicide varied by age group and included having prior contact with law enforcement and involvement in incidents that were precipitated by another crime, intimate partner violence, and drug dealing or substance use.

    Public Health Action: NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, Arizona and Wisconsin used their state-level Violent Death Reporting System (VDRS) data to support suicide prevention efforts within their respective states. Wisconsin VDRS used multiple years of data (2013–2017) to identify important risk and protective factors and subsequently develop a comprehensive suicide prevention plan. Arizona VDRS partners with the Arizona Be Connected Initiative to provide customized community-level data on veteran suicide deaths in Arizona. Similarly, states participating in NVDRS have used their VDRS data to examine intimate partner violence-related deaths to support prevention efforts. For example, data from the South Carolina VDRS were used to examine intimate partner homicides that occurred in South Carolina during 2017. South Carolina VDRS found that 12% of all homicides that occurred in 2017 were intimate partner violence-related, with females accounting for 52% of intimate partner homicide–related victims. These data were shared with domestic violence prevention collaborators in South Carolina to bolster their efforts in reducing intimate partner violence-related deaths. In 2018, NVDRS data included four additional states compared with 2017, providing more comprehensive and actionable violent death information for public health efforts to reduce violent deaths.

    Introduction

    In 2018, violence-related injuries led to approximately 68,000 deaths in the United States [1]. Suicide was the 10th leading cause of death overall in the United States and disproportionately affected young and middle-aged populations. By age group, suicide was the second leading cause of death for persons aged 10–34 years and the fourth leading cause of death for persons aged 35–54 years. During 2018, non-Hispanic American Indian or Alaska Native (AI/AN) and non-Hispanic White males were disproportionately affected by suicide.

    In 2018, homicide was the 16th leading cause of death overall in the United States but disproportionately affected young persons [1]. Homicide was among the five leading causes of death for children aged 1–14 years, was the third leading cause of death for persons aged 15–34 years and was the fifth leading cause of death for persons aged 35–44 years. Young non-Hispanic Black males also were disproportionately affected by homicide. Homicide was the leading cause of death for non-Hispanic Black males aged 15–34 years, the second leading cause of death for those aged 1–9 years, and the third leading cause of death for those aged 10–14 years.

    Public health authorities require accurate, timely, and complete surveillance data to better understand and ultimately prevent the occurrence of violent deaths in the United States [2,3]. In 2000, in response to an Institute of Medicine* report noting the need for a national fatal intentional injury surveillance system [4], CDC began planning to implement NVDRS [2]. The goals of NVDRS are to

    • collect and analyze timely, high-quality data for monitoring the magnitude and characteristics of violent deaths at national, state, and local levels;
    • ensure data are disseminated routinely and expeditiously to public health officials, law enforcement officials, policymakers, and the public;
    • ensure data are used to develop, implement, and evaluate programs and strategies that are intended to reduce and prevent violent deaths and injuries at national, state, and local levels; and
    • build and strengthen partnerships among organizations and communities at national, state, and local levels to ensure that data are collected and used to reduce and prevent violent deaths and injuries.

    NVDRS is a state-based active surveillance system that collects data on the characteristics and circumstances associated with violence-related deaths in participating states, the District of Columbia, and Puerto Rico [2]. Deaths collected by NVDRS include suicides, homicides, legal intervention deaths (i.e., deaths caused by law enforcement acting in the line of duty and other persons with legal authority to use deadly force, excluding legal executions), unintentional firearm deaths, and deaths of undetermined intent that might have been due to violence. The term “legal intervention” is a classification incorporated into the International Classification of Diseases, Tenth Revision ICD-10 [5] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.

    Before implementation of NVDRS, single data sources (e.g., death certificates) provided only limited information and few circumstances from which to understand patterns of violent deaths. NVDRS filled this surveillance gap by providing more detailed information. NVDRS is the first system to 1) provide detailed information on circumstances precipitating violent deaths, 2) link multiple source documents so that each incident can contribute to the study of patterns of violent deaths, and 3) link multiple deaths that are related to one another (e.g., multiple homicides, suicide pacts, or homicide followed by suicide of the suspect).

    NVDRS data collection began in 2003 with six participating states (Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) (Figure). Seven states (Alaska, Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) began data collection in 2004, three (Kentucky, New Mexico, and Utah) in 2005, two (Ohio and Michigan) in 2010, and 14 (Arizona, Connecticut, Hawaii, Illinois, Indiana, Iowa, Kansas, Maine, Minnesota, New Hampshire, New York, Pennsylvania, Vermont, and Washington) in 2015. In 2017, eight additional states (Alabama, California, Delaware, Louisiana, Missouri, Nebraska, Nevada, and West Virginia) began data collection, along with the District of Columbia and Puerto Rico.§ NVDRS received funding in 2018 for a nationwide expansion that included the remaining 10 states (Arkansas, Florida, Idaho, Mississippi, Montana, North Dakota, South Dakota, Tennessee, Texas, and Wyoming), which began data collection in 2019. CDC now provides NVDRS funding to all 50 states, the District of Columbia, and Puerto Rico. NVDRS data are updated annually and are available to the public through CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS) at https://www.cdc.gov/injury/wisqars/nvdrs.html. Case-level NVDRS data are available to interested researchers who meet eligibility requirements via the NVDRS Restricted Access Database (https://www.cdc.gov/violenceprevention/datasources/nvdrs/dataaccess.html).

    Enlarge

    Figure 1. States participating in the National Violent Death Reporting System, by year of initial data collection* — United States and Puerto Rico, 2003–2021

    Abbreviations: DC = District of Columbia; NVDRS = National Violent Death Reporting System; PR = Puerto Rico.
    * Map of the United States indicates the year in which the state or territory began collecting data in the National Violent Death Reporting System. California began collecting data for a subset of violent deaths in 2005 but ended data collection in 2009. In 2017, California collected data from death certificates for all NVDRS cases in the state; data for violent deaths that occurred in four counties (Los Angeles, Sacramento, Shasta, and Siskiyou) also include information from coroner or medical examiner reports and law enforcement reports. In 2018, California collected data from death certificates for all violent deaths in the state in 2018 (n = 6,641); data for violent deaths that occurred in 21 counties (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Mateo, San Diego, San Francisco, Shasta, Siskiyou, Ventura, and Yolo) also included information from coroner or medical examiner reports and law enforcement (n = 3,658; 55.1%). Michigan collected data for a subset of violent deaths during 2010–2013 and collected statewide data beginning in 2014. In 2016, Illinois, Pennsylvania, and Washington began collecting data on violent deaths in a subset of counties that represented at least 80% of all violent deaths in their state or in counties where at least 1,800 violent deaths occurred. 2018 data for Illinois are for violent deaths that occurred in 28 counties (Adams, Boone, Champaign, Cook, DuPage, Effingham, Fulton, Kane, Kankakee, Kendall, Lake, Lasalle, Livingston, Logan, McDonough, McHenry, McLean, Macoupin, Madison, Peoria, Perry, Rock Island, St. Clair, Sangamon, Tazewell, Vermillion, Will, and Winnebago). 2018 data for Pennsylvania are for deaths that occurred in 39 counties (Adams, Allegheny, Armstrong, Beaver, Berks, Blair, Bradford, Bucks, Cambria, Carbon, Centre, Chester, Clarion, Clearfield, Clinton, Columbia, Crawford, Dauphin, Delaware, Fayette, Forest, Greene, Indiana, Jefferson, Lackawanna, Lancaster, Lehigh, Luzerne, Monroe, Montgomery, Montour, Northampton, Philadelphia, Schuylkill, Union, Wayne, Westmoreland, Wyoming, and York). In 2018, Washington began collecting statewide data. Beginning in 2019, all 50 U.S. states, the District of Columbia, and Puerto Rico were participating in the system.

    This report summarizes NVDRS data on violent deaths that occurred in 39 states, the District of Columbia, and Puerto Rico in 2018. Thirty-six states (Alabama, Alaska, Arizona, Colorado, Connecticut, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin) collected statewide data, and three states collected data from a subset of counties in their states (21 California counties, 28 Illinois counties, and 39 Pennsylvania counties). This report highlights information about suspected perpetrators (suspects) of homicides in deaths in which information about the suspect is known, and law enforcement officers who inflicted fatal injuries in legal intervention deaths in which information about the officer is known. Information on suspects can be used to support violence prevention efforts by providing a more complete understanding of the contextual factors related to fatal violence perpetration and the circumstances surrounding these incidents.

    ___

    * The name of the Institute of Medicine was changed to the National Academy of Medicine, effective July 1, 2015.

    † To be included in NVDRS, deaths of undetermined intent must have some evidence of the possibility that the intent was purposeful, including use of a weapon or other evidence that force was used to inflict the injury. Most commonly, the coroner or medical examiner is unsure whether the death was a suicide or unintentional.

    § California began collecting data in 2005 but ended data collection in 2009. In 2018, 21 California counties (Amador, Butte, Fresno, Humboldt, Imperial, Kern, Kings, Lake, Los Angeles, Marin, Mono, Placer, Sacramento, San Benito, San Mateo, San Diego, San Francisco, Shasta, Siskiyou, Ventura, and Yolo) contributed data to NVDRS.

    ¶ Frequencies and rates of violent deaths included in this report differ slightly from the frequencies and rates of violent deaths reported by WISQARS, which excludes nonresident deaths that occur in participating states and the District of Columbia (i.e., occurrent deaths). NVDRS tracks both resident and occurrent violent deaths in the overall data set, and the numbers in this report reflect both. VDRS programs are expected to collect information on violent deaths among their residents, wherever they occur, and fatal violent injuries occurring within their borders irrespective of the decedent’s residence status. If the states of residence and injury occurrence are both participating NVDRS states, the state of injury occurrence is responsible for collecting the information. Making this differentiation of responsibility avoids duplicate reporting.