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

    processing....

    Methods

    NVDRS compiles information from three required data sources: death certificates, coroner and medical examiner reports, and law enforcement reports[2]. Some participating Violent Death Reporting System (VDRS) programs might also collect information from secondary sources (e.g., child fatality review team data, Federal Bureau of Investigation Supplementary Homicide Reports, and crime laboratory data). NVDRS combines 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. The ability to analyze linked data can provide a more comprehensive understanding of violent deaths. Participating VDRS programs use vital statistics death certificate files or coroner or medical examiner reports to identify violent deaths meeting the NVDRS case definition (see Manner of Death). Each VDRS program reports violent deaths of residents that occurred within the state, district, or territory (i.e., resident deaths) and those of nonresidents for whom a fatal injury occurred within the state, district, or territory (i.e., occurrent deaths). When a violent death is identified, NVDRS data abstractors link source documents, link deaths within each incident, code data elements, and write brief narratives of the incident.

    In NVDRS, a violent death is defined as a death resulting from the intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community[2]. NVDRS collects information on five manners of death: 1) suicide, 2) homicide, 3) legal intervention death, 4) unintentional firearm death, and 5) death of undetermined intent that might have been due to violence (see Manner of Death). NVDRS cases are coded based on ICD-10[5] or the manner of death assigned by a coroner, medical examiner, or law enforcement officer. Cases are included if they are assigned ICD-10 codes (Box 1) or a manner of death specified in at least one of the three primary data sources consistent with NVDRS case definitions.

    NVDRS is an incident-based system, and all decedents associated with a given incident are grouped in one record. Decisions about whether two or more deaths are related and belong to the same incident are made based on the timing of the injuries rather than on the timing of the deaths. Deaths resulting from injuries that are clearly linked by source documents and occur within 24 hours of each other (see Manner of Death) are considered part of the same incident. Examples of an incident include 1) a single isolated violent death, 2) two or more related homicides (including legal intervention deaths) when the fatal injuries were inflicted <24 hours apart, 3) two or more related suicides or deaths of undetermined intent when the fatal injuries were inflicted <24 hours apart, and 4) a homicide followed by a suicide when both fatal injuries were inflicted <24 hours apart[6].

    Information collected from each data source is entered into the NVDRS web-based system[2]. This system streamlines data abstraction by allowing abstractors to enter data from multiple sources into the same incident record. Internal validation checks, hover-over features that define selected fields, and other quality control measures are included. Primacy rules and hierarchal algorithms related to the source documents occur at the local VDRS program level. CDC provides access to the web-based system to each VDRS program. VDRS program personnel are provided ongoing coding training to learn and adhere to CDC guidance regarding the coding of all variables and technical assistance to help increase data quality. Data are transmitted continuously via the web to a CDC-based server. Information abstracted into the system is deidentified at the local VDRS program level.

    Manner of Death

    A manner (i.e., intent) of death for each decedent is assigned by a trained abstractor who integrates information from all source documents. The abstractor-assigned manner of death must be consistent with at least one required data source; typically, all source documents are consistent regarding the manner of death. When a discrepancy exists, the abstractor must assign a manner of death on the basis of a preponderance of evidence in the source documents; however, such occurrences are rare[6]. For example, if two sources report a death as a suicide and a third reports it as a death of undetermined intent, the death is coded as a suicide.

    NVDRS data are categorized into five abstractor-assigned manners of death: 1) suicide, 2) homicide, 3) legal intervention death, 4) unintentional firearm death, and 5) death of undetermined intent. The case definitions for each manner of death are described as follows:

    • Suicide. A suicide is a death of a person aged ≥10 years resulting from the use of force against oneself when a preponderance of evidence indicates that the use of force was intentional. This category also includes the following scenarios: 1) deaths of persons who intended only to injure rather than kill themselves; 2) persons who initially intended to kill themselves but changed their minds and died as a result of the act; 3) deaths associated with risk-taking behavior without clear intent to inflict fatal self-injury but associated with high risk for death (e.g., participating in Russian roulette); 4) suicides that occurred while under the influence of substances taken voluntarily; 5) suicides among decedents with mental health problems that affected their thinking, feelings, or mood (e.g., while experiencing an acute episode of a mental health condition such as schizophrenia or other psychotic conditions, depression, or posttraumatic stress disorder [PTSD]); and 6) suicides involving another person who provided only passive assistance to the decedent (e.g., supplying the means or information needed to complete the act). This category does not include deaths caused by chronic or acute substance use without the intent to die, deaths attributed to autoerotic behavior (e.g., self-strangulation during sexual activity), or assisted suicides (legal or nonlegal). Corresponding ICD-10 codes included in NVDRS are X60–X84, Y87.0, and U03 (Box 1).
    • Homicide. A homicide is a death resulting from the use of physical force or power, threatened or actual, against another person, group, or community when a preponderance of evidence indicates that the use of force was intentional. Two special scenarios that CDC’s National Center for Health Statistics (NCHS) regards as homicides are included in the NVDRS case definition: 1) arson with no specified intent to injure someone and 2) a stabbing with intent unspecified. This category also includes the following scenarios: 1) deaths when the suspect intended only to injure rather than kill the victim, 2) deaths resulting from a heart attack induced when the suspect used force or power against the victim, 3) deaths that occurred when a person killed an attacker in self-defense, 4) deaths resulting from a weapon that discharged unintentionally while being used to control or frighten a victim, 5) deaths attributed to child abuse without intent being specified, 6) deaths attributed to an intentional act of neglect by one person against another, 7) deaths of live-born infants that resulted from a direct injury due to violence sustained before birth, and 8) deaths identified as a justifiable homicide when the person committing the homicide was not a law enforcement officer. This category excludes vehicular homicide without intent to injure, unintentional poisoning deaths attributable to illicit or prescription drug overdose even when the person who provided the drugs was charged with homicide, unintentional firearm deaths (a separate category in NVDRS), combat deaths or acts of war, deaths of unborn fetuses, and deaths of infants that resulted indirectly from violence sustained by the mother before birth (e.g., death from prematurity after premature labor brought on by violence). Corresponding ICD-10 codes included in NVDRS are X85–X99, Y00–Y09, Y87.1, and U01–U02 (Box 1).
    • Legal intervention. A death from legal intervention is a death in which a person is killed or died as a result of injuries inflicted by a law enforcement officer or other peace officer (i.e., a person with specified legal authority to use deadly force), including military police, while acting in the line of duty. The term “legal intervention” is a classification from ICD-10 (Y35.0) and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement. Legal intervention deaths also include a small subset of cases in which force was applied without clear lethal intent (e.g., during restraint or when applying force with a typically nondeadly weapon, such as a Taser) or in which the death occurred while the person was fleeing capture. This category excludes legal executions. Corresponding ICD-10 codes included in NVDRS are Y35.0–Y35.4, Y35.6, Y35.7, and Y89.0 (Box 1).
    • Unintentional firearm. An unintentional firearm death is a death resulting from a penetrating injury or gunshot wound from a weapon that uses a powder charge to fire a projectile and for which a preponderance of evidence indicates that the shooting was not directed intentionally at the decedent. Examples include the following: 1) a person who received a self-inflicted wound while playing with a firearm; 2) a person who mistakenly believed a gun was unloaded and shot another person; 3) a child aged <6 years who shot himself or herself or another person; 4) a person who died as a result of a celebratory firing that was not intended to frighten, control, or harm anyone; 5) a person who unintentionally shot himself or herself when using a firearm to frighten, control, or harm another person; 6) a soldier who was shot during a field exercise but not in a combat situation; and 7) an infant who died after birth from an unintentional firearm injury that was sustained in utero. This category excludes injuries caused by unintentionally striking a person with the firearm (e.g., hitting a person on the head with the firearm rather than firing a projectile) and unintentional injuries from nonpowder guns (e.g., BB, pellet, or other compressed air-powered or gas-powered guns). Corresponding ICD-10 codes included in NVDRS are W32–W34 and Y86 (Box 1).
    • Undetermined intent. A death of undetermined intent in NVDRS is a death resulting from the use of force or power against oneself or another person for which the evidence indicating one manner of death is no more compelling than evidence indicating another. This category includes coroner or medical examiner rulings where records from data providers indicate that investigators did not find enough evidence to determine whether the injury was intentional (e.g., unclear whether a drug overdose was unintentional or a suicide). Corresponding ICD-10 codes included in NVDRS are Y10–Y34, Y87.2, and Y89.9 (Box 1).

    Variables Analyzed

    NVDRS collects up to approximately 600 unique variables for each death (Boxes 1, 2, and 3). The number of variables recorded for each incident depends on the content and completeness of the source documents. Variables in NVDRS include

    • manner of death (i.e., the intent to cause death [suicide, homicide, legal intervention, unintentional, and undetermined] of the person on whom a fatal injury was inflicted) (Box 1);
    • demographic information (e.g., age, sex, and race and ethnicity) of victims and suspects (if applicable);
    • method of injury (i.e., the mechanism used to inflict a fatal injury) (Box 2);
    • location, date, and time of injury and death;
    • toxicology findings (for decedents who were tested);
    • circumstances (i.e., the events that preceded and were identified by investigators as relevant and therefore might have contributed to the infliction of a fatal injury) (Box 3);
    • whether the decedent was a victim (i.e., a person who died as a result of a violence-related injury) or both a suspect and a victim (i.e., a person believed to have inflicted a fatal injury on a victim who then was fatally injured, such as the perpetrator of a homicide followed by suicide incident);
    • information about any known suspect (i.e., a person or persons believed to have inflicted a fatal injury on a victim);
    • incident (i.e., an occurrence in which one or more persons sustained a fatal injury that was linked to a common event or perpetrated by the same suspect or suspects during a 24-hour period); and
    • type of incident (i.e., a combination of the manner of death and the number of victims in an incident).

    Circumstances Preceding Death

    Circumstances preceding death are defined as the precipitating events that contributed to the infliction of a fatal injury (Box 3). Circumstances are reported on the basis of the content of coroner or medical examiner and law enforcement investigative reports. Certain circumstances are coded to a specific manner of death (e.g., history of suicide attempt is collected for suicides or deaths of undetermined intent); other circumstances are coded across all manners of death (e.g., current diagnosed mental health problem). The data abstractor selects from a list of potential circumstances and is required to code all circumstances that are known to relate to each incident. If circumstances are unknown (e.g., a body was found in the woods with no other details reported), the data abstractor does not endorse circumstances; these deaths are then excluded from the denominator for circumstance values. If either the coroner or medical examiner report or law enforcement report indicates the presence of a circumstance, then the abstractor endorses the circumstance (e.g., if the law enforcement report indicated that a decedent had disclosed an intent to die by suicide, then the circumstance variable “disclosed suicidal intent” is endorsed).

    Data abstractors draft two incident narratives that summarize the sequence of events of the incident: one from the perspective of the coroner or medical examiner report and one from the perspective of the law enforcement report. In addition to briefly summarizing the incident (i.e., the who, what, when, where, and why), the narratives provide supporting information on circumstances that the data abstractor indicated and context for understanding the incident, record information and additional detail that cannot be captured elsewhere, and facilitate data quality control checks on the coding of key variables.

    In NVDRS, the circumstance variable “intimate partner violence related” identifies cases in which the homicide or legal intervention death was related to immediate or ongoing conflict or violence between current or former intimate partners. In this report, intimate partner violence-related homicides include victims killed by an intimate partner (e.g., current, former, or unspecified spouse, boyfriend, or girlfriend) and those killed during an intimate partner violence–related homicide who were not the intimate partner (e.g., children, other family members, friends, or others who might have intervened in intimate partner violence [e.g., first responders or bystanders]).

    Coding Training and Quality Control

    Ongoing coding support for data abstractors is provided by CDC through an electronic help desk, monthly conference calls, annual in-person meetings that include coding training for data abstractors, and regular conference calls with individual VDRS programs. In addition, all data abstractors are invited to participate in monthly coding workgroup calls. VDRS programs can conduct additional abstractor training workshops and activities at their own discretion, including through the use of NVDRS Data Abstractor eLearn Training Modules. An NVDRS coding manual[6] with CDC-issued standard guidance on coding criteria and examples for each data element is provided to each VDRS program. Software features that enhance coding reliability include automated validation rules and a hover-over feature containing variable-specific information.

    VDRS programs are requested to reabstract a subset of cases using multiple abstractors to identify inconsistencies annually. Each VDRS program’s data quality is also evaluated by CDC. Before the data are released each year, CDC conducts a quality control analysis that involves the review of multiple variables for data inconsistencies, with special focus on abstractor-assigned variables (e.g., method of injury and manner of death). If CDC finds inconsistencies, the VDRS program is notified and asked for a response or correction. VDRS programs must meet CDC standards for completeness of circumstance data to be included in the national dataset. VDRS programs must have circumstance information abstracted from either the coroner or medical examiner report or the law enforcement report for at least 50% of cases. However, VDRS programs often far exceed this requirement. For 2018, a total of 85% of suicides, homicides, and legal intervention deaths in NVDRS had circumstance data from either the coroner or medical examiner report or the law enforcement report. In addition, core variables that represent demographic characteristics (e.g., age, sex, and race and ethnicity) and manners of death were missing or unknown for <0.5% of cases. To ensure the final dataset has no duplicate records, during the data closeout process, NVDRS first identifies any records within VDRS programs that match on a subset of 14 key variables and then asks VDRS programs to review these records to determine if they are true duplicates. In any set of records that are true duplicates, one record is retained and the others are deleted. Next, NVDRS uses SAS (version 9.4; SAS Institute) to search for any instances of duplicates of a unique identification variable associated with each decedent record. As a third and final check for duplicates, the SAS dataset is created with an index that only executes successfully if no duplicates of this identification variable are found.

    Time Frame

    VDRS programs are required to begin entering all deaths into the web-based system within 4 months from the date in which the violent death occurred. VDRS programs then have an additional 16 months from the end of the calendar year in which the violent death occurred to complete each incident record. For data collection year 2018 (original completion period through April 2020), VDRS programs were given an additional 3 months to complete incident records because of challenges encountered when deploying NVDRS system updates and delays in data collection caused by the COVID-19 pandemic. Although VDRS programs typically meet timeliness requirements, additional details about an incident occasionally arrive after a deadline has passed. New incidents also might be identified after the deadline (e.g., a death certificate is revised, new evidence is obtained that changes a manner of death, or an ICD-10 misclassification is corrected to meet the NVDRS case definition). These additional data are incorporated into NVDRS when analysis files are updated in real-time in the web-based system. Five months after the 16-month data collection period for the 2018 data year, case counts increased by <0.1%.

    Inclusion Criteria

    The inclusion criteria for violent deaths in this report are as follows: 1) cases met the NVDRS case definition for violent death; 2) cases occurred in participating VDRS states, the District of Columbia, or Puerto Rico in 2018; and 3) at least 50% of cases for each included state, district, or territory had circumstance information collected from the coroner or medical examiner report or law enforcement report. All but one eligible VDRS program that collected data in 2018 (Hawaii) met the completeness threshold for circumstances and were included in the report.

    Data for violent deaths occurring in 2018 are reported for 39 states, the District of Columbia, and Puerto Rico. Thirty-six states, the District of Columbia, and Puerto Rico collected data on all violent deaths occurring in their jurisdiction. Three of the 39 states (California, Illinois, and Pennsylvania) collected data from a subset of counties their state. In 2018, the 36 states that collected statewide data, 21 California counties, 28 Illinois counties, 39 Pennsylvania counties, and the District of Columbia accounted for 72.0% of the U.S. population[7].

    Of the participating VDRS programs, 36 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 information on all violent deaths that occurred in their states in 2018. In addition, data were collected on all violent deaths that occurred in the District of Columbia and Puerto Rico in 2018. Two states (Illinois and Pennsylvania) joined NVDRS with plans to collect 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. In 2018, these states reported data on a subset of counties that represented at least 80% of violent deaths in their state. Data were collected for 28 counties in Illinois that represented 86.0% 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)[7]. In Pennsylvania, data were collected for 39 counties that represented 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)[7]. California collected data from death certificates for all violent deaths in the state in 2018 (n = 6,641) (Supplementary Table S2, https://stacks.cdc.gov/view/cdc/112767). 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 reports and are included throughout the rest of the report (n = 3,658; 55.1%). These 21 counties represented 54.0% of California’s population[7]. Because <100% of violent deaths were reported, data from California, Illinois, and Pennsylvania are not representative of all violent deaths occurring in these three states.

    Analyses

    This report includes data for violent deaths that occurred in 2018 in 39 states, the District of Columbia, and Puerto Rico. VDRS program-level data were received by CDC by the extended date of July 31, 2020; an additional 2-week extension was given to New York because of severe disruptions in data collection caused by the COVID-19 pandemic. All data received by CDC as of August 14, 2020, were consolidated and analyzed. The numbers, percentages, and crude rates are presented in aggregate for all deaths by the abstractor-assigned manner of death. The suicide rate was calculated using denominators among populations aged ≥10 years. The rates for other manners of death used denominators among populations of all ages. The rates for cells with frequency <20 are not reported because of the instability of those rates. Denominators for the rates for the three states that did not collect statewide data (California, Illinois, and Pennsylvania) correspond to the populations of the counties from which data were collected. The rates could not be calculated for certain variables (e.g., circumstances) because denominators were unknown.

    Bridged-race 2018 population estimates were used as denominators in the crude rate calculations for the 36 states that collected statewide data, 21 California counties, 28 Illinois counties, 39 Pennsylvania counties, and the District of Columbia[8]. For compatible numerators for the rate calculations to be derived, records listing multiple races were recoded to a single race, when possible, using race-bridging methods described by NCHS (https://www.cdc.gov/nchs/nvss/bridged_race.htm)[9]. The rates specific to race and ethnicity are not available for Puerto Rico because the U.S. Census Bureau estimates for Puerto Rico do not include race or Hispanic origin[10]. Data for Puerto Rico were analyzed separately. Population estimates by sex and age were used as denominators in the crude rate calculations for Puerto Rico[11].