System helps find preventive solutions for violent deaths: Researchers encouraged to use data
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* Mark Barna

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Researchers are using data from NVDRS to learn why violent deaths happen. Police reports, coroner records and even media reports offer vivid narratives that aid research.

Photo by Poba, courtesy iStockphoto

Sometimes it is all in the details. For Sheryl Chatfield, PhD, of Kent State University, those details led to innovative research with surprising discoveries.

Chatfield conducted her research using the National Violent Death Reporting System, which shares data on violent deaths at a national level and goes far beyond the statistics of most mortality databases.

In 2002, the Centers for Disease Control and Prevention launched NVDRS by collecting data in six states and setting up an online resource site. Today, data is collected in every state, Puerto Rico and the District of Columbia. All types of violent deaths are covered, including homicide, suicide and unintentional firearm-related deaths.

NVDRS combines information from police reports, medical examiner and coroner reports, toxicology reports, death certificates, vital records and more. States receive federal funding to abstract their reports. With the linked information, the system is able to provide a more complete picture of the circumstances that contribute to violent deaths, offering researchers an opportunity for innovative analysis.

“NVDRS data increase our knowledge about where violent deaths occur, who is most at risk and the factors that contribute to violent deaths,” Katherine Fowler, PhD, senior scientist in the Division of Violence Prevention at the Centers for Disease Control and Prevention, told *The Nation’s Health.* “These data provide the foundation for building successful strategies for preventing violence so that all communities can be safe and free from violence and people can live to their full potential.”

About 67,000 people died violently in the U.S. in 2017. In a NVDRS Surveillance Summary published in December, data from over 46,000 of those cases were shared. The information, which came from 34 states, Puerto Rico and the District of Columbia, showed that, of overall violent deaths, 63% were suicides and 25% were homicides. A firearm was used in half of suicides and in most homicides. Homicide was the leading cause of death for Black males ages 15-34. American Indian and Alaska Native men were killed by police at the highest relative rate, 2.8 per 100,000 population, seven times that of white males, the data showed. Black American males were killed at 1.2 per 100,000.

Researchers are digging through the new data to understand the context of U.S. homicides and other violent deaths, and developing preventive strategies.

“By having a clear understanding of the issues surrounding these deaths, we can focus on community-level interventions and provide supports to counter the cycle of violence,” said Mighty Fine, MPH, CHES, director of APHA’s Center for Public Health and Professional Development. “It also positions us to evaluate our current prevention efforts and determine their effectiveness at addressing the root causes of violence.”

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By using data from NVDRS, researchers can help reduce the toll of violence, which ends more than 65,000 U.S. lives a year.

Infographic excerpt courtesy CDC

In partnership with CDC’s National Center for Injury Prevention and Control, APHA created the NVDRS New Investigator Research Award program to encourage researchers who received a doctoral degree within the past five years to use NVDRS to analyze violent death data and submit findings for publication. Researchers have focused on topics such as homicides of pregnant women, events surrounding suicides by military veterans and intimate partner violence among adolescents.

Amy Hunter, PhD, an assistant professor of community medicine and health care at the University of Connecticut, received the award in 2018 to research child homicides. She and colleagues examined NVDRS information in 17 states between 2011 and 2015 and found 1,023 cases among newborns to 10-year-olds.

In almost half the cases, a child’s father or stepfather was the perpetrator, according to the study, published in 2019 in the *Journal of Interpersonal Violence.* The data also showed that an intimate partner killed a child in the home in 22% of cases. The research revealed a little-discussed fatality risk: a man, his intimate partner and a child of whom he is not the biological father living under one roof.

NVDRS enabled Hunter to find vivid narratives from police reports and other sources that told a rare but tragic story, brought to the surface by the system’s granular data and large sample size. Based on the findings, Hunter and her co-authors called for interventions focused on men and research on child violence by parental intimate partners.

“It is such a rich source of data and it really allows for so many different types of analyses,” Hunter told *The Nation’s Health.*

Chatfield, an assistant professor at the College of Public Health at Kent State, received an APHA award in 2018 for NVDRS research. She set out to analyze intimate partner violence, but instead discovered a little-known trend in assisted-living communities for older adults.

She researched 101 homicides involving long-term care roommates between 2003 and 2016, combing through linked police reports, medical reports, death certificates and even media stories. A typical case involved a senior who kills his roommate, who is over a decade older and suffering from dementia. In 2019, Chatfield co-authored a study on the results that appeared in the *Journal of Applied Gerontology.*

“NVDRS probably facilitates putting that information together better than any other data set that may try to capture that information,” Chatfield told *The Nation’s Health.*

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Scientific findings that incorporate NVDRS data can be used to inform decisionmakers and influence public health policy.

Photo by DNY59, courtesy iStockphoto

She has also used the system to research youth suicides, looking for evidence whether adolescents ages 9-17 were experiencing conflicts with family or friends in the 24 hours preceding their death. Nearly 200 cases were found across multiple states describing the social context of the final hours prior to suicide.

Chatfield thought she would find bullying. To her surprise, a quarter of cases involved strife between parent and child due to restricted cellphone use, social media use or both. Restricting technology was either a primary or secondary cause of suicide for adolescents at the lower ages of the study.

“About every other type of data that researchers use is more about suicide intention or self-harm,” Chatfield said. “But we were looking at actual cases and could see the actual behavior, which is different than someone talking about (suicide).”

To help prevent suicides among youth, the Centers for Disease Control and Prevention recommends reducing access to lethal means, strengthening family relationships, teaching coping and problem-solving skills, and increasing access to mental health care.

This year, NVDRS added the School-Associated Violent Death Surveillance System, which reports deaths on school grounds and during school events. The data will help assess national trends in school-related violent deaths. The system also recently received funding to develop the Public Safety Officer Suicide Reporting System module to cover suicides among police officers.

For information on using the National Violent Death Reporting System for research and gaining access to system data, visit [bit.ly/CDC\_NVDRS](http://bit.ly/CDC_NVDRS).

For information on the New Investigator Research Awards, visit [bit.ly/NVDRSawards](http://bit.ly/NVDRSawards) or email mighty.fine{at}apha.org

*   Copyright The Nation’s Health, American Public Health Association