Tuesday, March 28, 2023
| 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.
| 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.
| 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).
| 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).
| 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).
| 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%).
| 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.
| 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).
| 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.
| 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.
| 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.
| 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
|
• 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
| 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
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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.
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Violent deaths affect males and females and persons of all ages, races, and ethnicities. NVDRS data on specific manners of violent death can be used to describe characteristics of and inequities experienced by populations particularly affected by fatal violence. NVDRS data can also be used to identify cross-cutting risk factors for multiple forms of violence. These details increase the knowledge base about the circumstances associated with violence and can assist public health authorities and their partners in developing and guiding effective, data-driven approaches to violence prevention.
The occurrence of violent death varies greatly across states, the District of Columbia, and Puerto Rico [1]. This report summarizes data on violent deaths that occurred in 2018 in 39 states and the District of Columbia, representing 72.0% of the U.S. population and accounting for 72.9% of violent deaths in the United States in 2018 [1], and Puerto Rico. In 2019, NVDRS expanded data collection to include all 50 states, the District of Columbia, and Puerto Rico, providing more comprehensive, accessible, and actionable violent death information that can be used to guide the development of evidence-based violence prevention efforts at local, regional, state, and national levels. Expanding NVDRS to a nationwide system also contributes to the national prevention initiative Healthy People 2020 objectives to increase the number of states that link data on violent deaths from death certificates, coroner or medical examiner reports, and law enforcement reports at state and local levels and the Healthy People 2030 objectives to reduce the number of suicides, homicides, and firearm-related deaths [12,13].
Violence is preventable, and reducing violent deaths in communities is possible with evidence-based approaches, such as those outlined in CDC’s technical packages for violence prevention [14]. CDC developed technical packages to assist communities in identifying violence prevention approaches that are based on the best available evidence. The five technical packages describe strategies, approaches, and specific programs, practices, and policies with evidence to reduce the risk for suicide, youth violence, child abuse and neglect, intimate partner violence, and sexual violence. Each technical package considers the multifaceted and interactive effects of different levels of the social ecology, including individual, relationship, family, school, and community factors that influence violence-related outcomes. NVDRS gathers ongoing, systematic, and consistent data on violent deaths that can be used by violence prevention experts within their communities to guide planning and implementation and track outcomes of violence prevention strategies and approaches.
Suicide rates were highest among males and adults aged 45–64 years. Approximately one third of suicide decedents had a history of suicidal thoughts or plans, and approximately one fourth had disclosed their suicidal intent. Mental health problems were the most commonly identified circumstance; however, approximately one half of suicide decedents did not have a known mental health condition at the time of their death. Past suicidal behavior and mental health problems are important risk factors for suicide [15], and these circumstances are well documented as important risk factors to target in suicide prevention [15,16]. Approximately one third of suicide decedents were known to be receiving treatment at the time of death, pointing to a gap between those receiving treatment and those who would likely benefit from it. Multiple factors contribute to the risk for suicide [17], and the findings in this report indicate that intimate partner problems, recent or impending crises, and physical health problems also were common precipitating circumstances. A high prevalence of alcohol use was observed among suicide decedents tested for substances, especially those with BAC ≥0.08g/dL. Alcohol use is a robust predictor of suicidal behavior [18], victimization [19], and interpersonal violence perpetration [20,21]. Intoxication can lead to disinhibition, enhance feelings of hopelessness and depression, and impair judgment, which can lead to impulsive behaviors [16].
Another factor that might contribute to the risk for suicide is access to lethal means [15]. Similar to rates observed for alcohol and antidepressants, toxicology results for opioids (illicit or prescription) were positive in approximately one fourth of suicide decedents who were tested for these substances. Opioid overdose has been recognized as an epidemic [22]. CDC published the Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for primary care physicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care and end-of-life care to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, support safer prescribing practices, and reduce the risks associated with long-term opioid therapy including opioid use disorder, overdose, and death [23]. Previous research suggests that chronic pain might be a contributor to suicide; for this reason, these guidelines also aim to ensure that patients receive appropriate care for pain [24]. Building on previous CDC programs focused on opioid overdose and injury prevention, CDC also has implemented comprehensive surveillance and prevention activities through Overdose Data to Action to support state and local health departments in collecting and reporting more timely and complete data on overdose morbidity and mortality and using the data to inform prevention and response efforts [25–27]. Other activities to address the opioid overdose epidemic include expanding naloxone availability and access to treatment with medications for opioid use disorder, enhancing public health and public safety partnerships, and maximizing the ability of health systems to link persons to treatment and harm-reduction services [25–28]. A firearm was the most common method used in suicides. Lethal means, such as firearms, provide limited opportunity for intervention and have high case-fatality rates [15]. Creating protective environments by reducing access to lethal means among persons at-risk can be an effective strategy to prevent suicide [15].
Demographic variations persist in the manner of death from violence-related injuries. Suicides comprise the majority of violent deaths collected in NVDRS and occur at higher rates among non-Hispanic AI/AN and White persons. The findings regarding suicide rates experienced by non-Hispanic AI/AN persons warrant attention to the contextual factors that might contribute to higher rates of suicide, such as barriers to accessing mental health care, exposure to the suicide of a friend or family member as a contributing factor to one’s own death by suicide, and alcohol and substance use [29]. AI/AN persons’ experiences with historical trauma related to the intergenerational, collective, and cumulative impact of colonialism and ongoing inequities including discrimination, disparaging stereotypes, and microaggressions can contribute to risk for suicide [30,31]. Challenges related to suicide, alcohol, and substance use are not inherent to AI/AN culture but should be interpreted within the context of historical racism and ongoing inequities. The heterogeneity among persons and groups that identify as AI/AN also should be acknowledged [29,30].
States participating in NVDRS have used their data to support prevention efforts. NVDRS programs often partner with collaborators to provide data on violent deaths, and those collaborators in turn use the data to guide prevention efforts. For example, Arizona and Wisconsin use their VDRS data to support suicide prevention efforts within their respective states. Arizona VDRS partners with Arizona’s statewide Be Connected initiative to provide customized community-level data on veteran suicide deaths in Arizona. Be Connected directly engages in veteran suicide prevention, including staffing a support line, providing resource matching and navigation, and training for the community [32]. This partnership demonstrates the applied use of NVDRS data for Arizona, and consequently allows for proactive outreach to and engagement with veterans at risk for suicide.
Wisconsin VDRS used multiple years of data (2013–2017) to identify important risk and protective factors and subsequently develop a comprehensive suicide prevention plan for Wisconsin. Wisconsin VDRS found that during 2013–2017, suicide rates were highest among non-Hispanic White and AI/AN persons [33]. Non-Hispanic groups had higher rates of suicide than the Hispanic population, and nonfatal self-harm injury rates were highest among non-Hispanic Black and AI/AN persons [33]. Rural counties had higher suicide rates compared with urban and suburban counties [33]. In addition, 25% of suicide decedents had a previous suicide attempt, and 20% had a reported job problem, financial problem, or both [33]. These findings demonstrated the impact of suicide in Wisconsin and prompted the development of the Wisconsin Suicide Prevention Plan [33], which is a comprehensive plan designed to increase the effectiveness of suicide prevention efforts in Wisconsin. In addition, to address high rates of suicide among at-risk populations, the plan proposes to expand access to services for mental health and substance use treatment (including physical health care), support innovative ways to expand access to care, including technologies and peer-led or other nonclinical support services, and increase the public’s knowledge of suicides, which includes recognizing warning signs and preparedness to support and respond to persons at risk. This plan highlights the importance of using the best available data; mobilizing coordinated, effective efforts by state agencies, local suicide prevention coalitions, and other partners; facilitating statewide impact of evidence-based and best practices; and monitoring the progress of the prevention plan at the state level, all of which might help to reduce the overall number of suicides in Wisconsin.
CDC’s suicide prevention technical package describes seven strategies for reducing suicide and suicidal behaviors: 1) strengthen economic supports, 2) strengthen access to and delivery of suicide care, 3) create protective environments, 4) promote connectedness, 5) teach coping and problem-solving skills, 6) identify and support persons at risk, and 7) decrease harms and prevent future risk [14]. These strategies support the goals and objectives of the National Strategy for Suicide Prevention (NSSP), which is a comprehensive national agenda for suicide prevention [34], and the National Action Alliance for Suicide Prevention’s priority to strengthen community-based prevention [35]. NVDRS is relevant to NSSP’s goals of increasing timeliness and usefulness of surveillance systems related to suicide prevention and evaluating outcomes and effectiveness of suicide prevention interventions. The suicide prevention technical package includes examples of specific approaches that communities can implement to advance each strategy. The findings in this report underscore the importance of approaches outlined in the suicide technical package, such as social-emotional learning programs, enhancing parenting skills and family relationships, and treatment for persons at risk for suicide and treatment to prevent reattempts.
Infants experienced a high homicide rate, highlighting the need for prioritizing child abuse and neglect prevention and intervention strategies to reduce risk for morbidity and mortality. Child abuse and neglect are often associated with immediate physical injuries, emotional and psychological problems, involvement in risky health behaviors later in life, and a host of broader physical health challenges and long-term health consequences [36].
CDC’s child abuse and neglect prevention technical package identified the following evidence-based strategies and approaches: 1) strengthening economic supports for families, 2) changing social norms to support parents and positive parenting, 3) providing quality care and education early in life, 4) enhancing parenting skills to promote healthy child development, and 5) intervening to decrease harms and prevent future risk [36]. Child abuse and neglect are preventable, and the specific approaches described in the technical package can help create safe, stable, and nurturing relationships and environments [37] to prevent homicides of infants and children as well as nonfatal child maltreatment.
Racial and ethnic minority groups experience inequitable rates of violent injury and homicide, particularly among youths and young adult males [38]. In the United States, homicide rates were highest among non-Hispanic Black and AI/AN persons. In Puerto Rico, where 95.1% of homicide victims were Hispanic, the homicide rate was more than double the suicide rate. Male homicide victims in Puerto Rico were predominantly Hispanic (94.8%) and experienced homicide rates similar to and even exceeding the homicide rates experienced by non-Hispanic Black, non-Hispanic AI/AN, and Hispanic males in the United States. Racial and ethnic inequities in exposure to violence are pervasive and persistent, and the elimination of these inequities should be prioritized [38]. Racial and ethnic minority groups are disproportionately exposed to systemic inequities such as residential segregation, concentrated disadvantage, stress from experiencing racism, limited access to the best educational and employment opportunities, and other conditions that increase the risk for experiencing violence [38–40]. For example, homicide rates for males in Puerto Rico have been attributed, in part, to persons living in communities that have been marginalized and the socioeconomic incentives of being involved in illegal means of income that are associated with high risks for violence [41]. Racial and ethnic minority youths often live in communities with concentrated poverty, stressed economies, residential instability, neighborhood disorganization, and low community cohesion and informal controls [35,36]. These conditions are associated with violence and violence-related injuries [39]. By addressing the structural, societal, and community-level contexts that serve as risk factors for violence, prevention efforts can have broad and sustained effects [3,41,42].
NVDRS programs have used their local data to examine violence-related disparities in their states. For example, the Illinois VDRS used 2016–2017 Illinois VDRS data to examine the intersection of homicide and poverty at the county-level and found a relation between homicide and poverty in two thirds of the counties that were examined [43]. Similarly, Illinois VDRS examined firearm-related homicide rates among non-Hispanic Black males aged 15–19 years in Chicago during 2013–2017 and found that the 2017 firearm-related homicide rate among Black males in Chicago aged 15–19 years was 74% higher than that in 2013 [44]. During 2013–2017, non-Hispanic Black males in Chicago aged 15–19 years had an increased risk for firearm-related homicide compared with all persons in the United States and Chicago in this age group. Although firearm-related homicide risk for non-Hispanic Black males aged 15–19 years fluctuated during 2013–2017, in 2017, non-Hispanic Black males aged 15–19 years in Chicago were 13.7 times more likely to be victims of firearm-related homicide compared with non-Black males in this age group [44]. These findings indicate increasing disparities between young non-Hispanic Black males in Chicago and all other young males in the United States. In conjunction with other data sources, NVDRS data can help states identify and target salient neighborhood- and community-level factors related to violence, which can contribute to greater population-level decreases in violence through the reduction and elimination of systemic inequities [45]. CDC’s youth violence prevention technical package outlines several community- and societal-level programs and approaches [14], such as Baltimore’s Safe Streets [46], Crime Prevention Through Environmental Design [47], business improvement districts [48,49], and policies such as the Earned Income Tax Credit (EITC) [50,51]. For example, enhancing household financial security through tax credits, such as the EITC, can help families raise their income while incentivizing work or counterbalancing the costs of child-rearing and help create home environments that encourage healthy development [50,51]. Evaluations of these programs and policies have confirmed the value of using these types of approaches to reduce the risk for violence and promote protective community environments [14]. Evidence also suggests that these approaches and other universal policies that focus on general community improvements can have a substantial impact on decreasing racial and ethnic inequities in violence [39].
Homicides among males were most often preceded by an argument or conflict or precipitated by another crime, and the suspect was most often an acquaintance or friend. In contrast, approximately 45% of homicides among females were related to intimate partner violence, and a current or former intimate partner was identified as the suspect for approximately one half of female homicide victims with known suspects. These findings were consistent with another NVDRS report that highlighted the differential impact of intimate partner violence–related homicides among young and racial and ethnic minority women [52]. Intimate partner violence affects millions of persons in the United States each year [53]. Estimates from the 2015 National Intimate Partner and Sexual Violence Survey indicated that approximately 80 million persons in the United States have experienced intimate partner violence (e.g., contact sexual violence, physical violence, and stalking by an intimate partner) at some point in their lives, and approximately 12 million persons experienced intimate partner violence in the previous 12 months [53].
Although approximately one half (49.2%) of homicides involving intimate partner violence were perpetrated by suspects aged 25–44 years, among suspects aged 45–64 years and those aged ≥65 years, the victim was most often a current or former intimate partner. For example, suspects aged ≥65 years accounted for only 8.5% of suspects involved in intimate partner violence–related homicides overall; however, 58.2% of suspects within this age group were involved in intimate partner violence–related homicides. Studies examining older adult perpetration of intimate partner homicide have highlighted the potential influence of factors such as relationship discord, impending separation, caregiver-related stressors, and physical and mental health problems have on intimate partner violence [54,55]. Intimate partner violence–related homicides warrant further research to determine the contextual factors and characteristics of these fatal incidents and how these contextual factors might vary by age group.
NVDRS programs have used their data to examine intimate partner violence–related deaths to support prevention efforts [56]. Data from the South Carolina VDRS were used to examine intimate partner homicides that occurred in South Carolina during 2017 [56]. South Carolina VDRS found that 12% of all homicides that occurred in 2017 were intimate partner violence related, with females accounting for 52% of intimate partner violence–related homicide victims. In addition, approximately one in three intimate partner violence–related homicides occurred during an argument, and an argument contributed to the death of 44% of males and 41% of female homicide victims in South Carolina in 2017. These data were shared with domestic violence prevention collaborators in South Carolina to bolster their efforts in reducing intimate partner violence–related deaths.
CDC’s intimate partner violence prevention technical package outlines several strategies for programs and policies to prevent intimate partner violence and to decrease harms [57]. Strategies and approaches to prevent and reduce intimate partner violence might occur across different levels of the social ecology, such as engaging men and boys as allies [57,58]; disrupting developmental pathways toward intimate partner violence; creating protective school, workplace, and neighborhood environments [57]; teaching youths about safe and healthy relationships [57,58]; empowering bystanders; and strengthening economic supports to families [57]. Prevention efforts can help change harmful gender norms that condone violence and the societal conditions that serve to maintain those norms [57,59].
Most homicide suspects with known age were males aged 18–44 years, which is consistent with previous studies describing homicide suspect demographics [60]. Most suspects were accused of fatally injuring an acquaintance or friend, or a current or former intimate partner or spouse. The data provide more insight into the potential context of homicides when victim-suspect relationships are examined by age group. For example, among persons aged ≤24 years, suspects were most often accused of fatally injuring an acquaintance or friend, stranger, or other person whom they knew but who was not a relative. For suspects aged ≥24 years, increasingly larger proportions of current or former intimate partners or spouses were reflected in the victim-suspect relationship than proportions of other types of victim-suspect relationships. Attempting suicide after a homicide was another prominent contextual factor among those aged ≥45 years. The considerable prevalence of current or former intimate partners as victims and attempted suicide after the homicide are consistent with a previous study that identified having a history of intimate partner conflict as common among homicide-suicide incidents [60].
A mental health problem was noted as a direct contributing factor to the homicide for <5% of suspects, which challenges public perceptions of associations between mental health problems and violent behavior [61]. Exploring contexts in which mental health problems are a contributing factor and dispelling stigma that can lead to discrimination and present barriers to life opportunities for those living with persistent mental health challenges are important [61]. Approximately 12% of suspects were noted as having contact with law enforcement within the 12 months before the homicide. Prior contact with law enforcement included instances in which the police were called, regardless of whether an arrest was made [6]. This finding warrants future research to determine the extent and nature of prior law enforcement contact and the potential opportunity for law enforcement to disrupt pathways toward escalating forms of violence, including homicide.
Additional research to examine how incident contexts and risk and protective factors for homicide perpetration vary across age groups can help guide approaches to violence prevention and identify potential intervention points for reducing onset or progression of violence within relationships and communities. Individual, relationship, and community-level interventions that prevent initial violence perpetration or escalating violence are an important part of a comprehensive approach to violence prevention as described in CDC’s technical packages for violence prevention.
NVDRS collects more complete information than other data sources on legal intervention deaths [62]. The rate of legal intervention death was highest among non-Hispanic AI/AN persons, and the rate among non-Hispanic Black males was 2.6 times that of their non-Hispanic White male counterparts, a finding consistent with previous studies [63,64]. Racial and ethnic inequities in fatal police shootings have been examined in violence literature [63,65–67] and have been attributed to factors such as increased police contact caused by more traffic stops, a higher presence of law enforcement in racial and ethnic minority communities, and race-based bias and perceptions of threat. More analyses are needed to increase knowledge about the magnitude and circumstances of these deaths and for developing appropriate prevention strategies and monitoring their effectiveness. Other studies have provided a review of strategies for decreasing legal intervention deaths, such as increasing training in conflict de-escalation and tactical disengagement, and training to reduce potential bias in law enforcement officers’ responses to suspects [63,65]. After a number of high-profile legal intervention deaths including the murder of George Floyd in 2020, several policy changes have been proposed to reduce police violence and enhance relationships between law enforcement and the communities they serve. These proposals include strengthening and monitoring local police use-of-force policies, recruiting a diverse police force, and training officers in appropriate and safe interactions with the community [68].
A unique strength of the NVDRS surveillance system is the ability to capture data on suspects, including characteristics of law enforcement officers involved in legal intervention deaths [2,63]. Although 49.4% of 2018 NVDRS legal intervention incidents had unknown demographic and circumstance information for the officers involved, the available information provided some insight into the officers involved in violent deaths that occurred in the line of duty. When demographic information was known, law enforcement officers involved in legal intervention deaths were most frequently non-Hispanic White males aged 25–44 years. The demographics of law enforcement officers involved in legal intervention deaths are consistent with demographics of the U.S. police force, which tends to be predominantly comprised of non-Hispanic White males [69]. Although not examined in the current report, a previous study examining characteristics of officers involved in legal intervention deaths found associations between officer use of lethal force and demographic characteristics such as race, age, sex, and education as well as previous use of force [70]. Given previous findings on officers involved in legal intervention deaths and the importance of NVDRS for capturing information on legal intervention deaths, researchers have called on NVDRS to increase the completeness of demographic information on officers involved in these deaths [63,70].
NVDRS has been recognized as a reliable source of data on unintentional firearm deaths [71] and for its ability to provide details about victims and shooters [72]. Approximately one half of unintentional firearm deaths were self-inflicted; however, approximately one third were known to have been inflicted by another person. Most of these deaths occurred while playing with a gun, accidentally pulling the trigger, or thinking the gun was unloaded, which are of concern, particularly among children [73]; these findings highlight the importance of safe storage practices and education about safe handling of firearms [74].
