CDC launches program to track violent deaths

A public health approach is being applied to the nation's high homicide and suicide rates.

By Susan J. Landers, amednews staff. Sept. 15, 2003.

Washington -- Violence is a major public health threat, and in an attempt to reduce its high death toll, the Centers for Disease Control and Prevention is readying a crucial tool -- good national data.

The 46,000 homicides and suicides in the United States each year far exceed the fewer than 2,000 deaths caused annually by the flu and vastly overwhelm the 19 deaths caused so far in 2003 by the attention-grabbing West Nile virus.

Show me the data
Links
See related content

Even so, violent death tends to be more closely associated with the criminal justice system, and effective public health interventions to lower its numbers are scarce.

That could change.

The agency's National Violent Death Reporting System is a "very needed and valuable program," AMA Executive Director Michael Maves, MD, told CDC Director Julie Gerberding, MD, MPH, in an Aug. 13 letter.

Experts in the injury prevention field echo this view.

The U.S. has 46,000 homicides and suicides each year.

"I personally think this is going to be a tremendously important undertaking as the number of states is increased and this becomes a national system," said Jon Vernick, associate professor at Johns Hopkins Bloomberg School of Public Health and co-director of Hopkins' Center for Gun Policy and Research.

"For the first time ever we're going to have really good, detailed information about homicides and incredibly rich information about suicide, which we never had before," said David Hemenway, PhD, professor of health policy at Harvard School of Public Health.

The CDC hopes eventually to fund all 50 states and the District of Columbia to develop a national system for tracking violent death that is similar to the Fatality Analysis Reporting System operated by the National Highway Traffic Safety Administration. Created in 1975, this system tracks motor vehicle accident deaths and has led to numerous improvements in motor vehicle safety.

So far, the CDC is funding projects in 13 states that are collecting data from medical examiners, coroners, police, crime labs and death certificates. "This is the first time that a system to track all violent fatalities has involved that linkage of data," said Richard Withers, co-director of the Medical College of Wisconsin's Firearm Injury Center. The Medical College and Harvard took the lead in developing the reporting system the CDC adopted.

Finding solutions

The resulting data are expected to answer fundamental questions about trends and patterns of violence. Using a public health perspective to fashion interventions and evaluate programs means collecting data on the environment, the agent and vehicle of injury, and the victim's circumstances, Withers said.

Wisconsin's center has employed that approach to the reduction of violent injuries and deaths since its 1997 founding. For example, the center recently analyzed gun buy-back programs, an idea that has caught on in communities nationwide as a way to get firearms off the streets. However, "Our analysis found that the guns that are routinely recovered in buy-back programs are simply not the same type of firearms used in homicides or suicides," Withers said.

Suicide is a greater problem in Wisconsin's rural areas than its urban ones.

Rather than say "forget this type of program," the Wisconsin analysis recommended specifying which make, model and caliber of firearms should be collected, he said. People were often turning in old hunting rifles, shotguns or outdated revolvers rather than easily concealable guns.

In probing violent deaths, the CDC reporting system undoubtedly will open up new data on suicide, which makes up the majority of such deaths, Dr. Hemenway said. "In suicides, we only have the death certificates, which tell you nothing about the circumstances."

The new data are expected to help answer such questions as "Are people seeing mental health professionals? Or, are they seeing mental health professionals who aren't doing enough?"

Suicide was also determined to be a much greater problem in Wisconsin's rural areas than in urban areas. In view of this finding, communities are advised to educate people about the likelihood of suicide and to pay heed to rural needs for social supports.

Meanwhile, the NHTSA's reporting system is hailed as a successful model for the new CDC program.

"The system has been used to answer all sorts of questions about risk factors for motor vehicle crash deaths and, more importantly, interventions," Vernick said. "We get information on whether seat belt laws are working, about the relationship between alcohol and motor vehicle crashes and increasing the legal drinking age."

"It has been a spectacularly useful data system for researchers like me," he added. "At a time when the number of cars on the road has gone up, the number of people in the United States has gone up and the number of miles we travel has gone up, the motor vehicle crash death rate per mile traveled has declined by about 70%."

The CDC project has been a long time in coming. Foundations have provided support for several prototype systems in academic centers in recent years. Harvard created such a program. "We showed in the pilot that you can collect this data and it's not that expensive," Dr. Hemenway said.

The foundation funders helped create a movement. "You had the AMA, the American Assn. of Suicidology and 70 other organizations saying this was important," he said. "Now we have a chance to do this, and it's so cheap and it can matter forever. Twenty or 30 years from now the system will still be collecting good data. It's not some little intervention."

ADDITIONAL INFORMATION:

Show me the data

The Centers for Disease Control and Prevention's National Violent Death Reporting System will track violent deaths in all 50 states and the District of Columbia by collecting information that could answer fundamental questions about trends and patterns of violence. Data will be compiled from: