School-associated student homicides--United States, 1992-2006

School-associated student homicide events, especially those involving multiple victims, generate considerable media attention, prompting questions regarding whether rates of school-associated violent deaths are increasing and regarding the characteristics of such events. During the 1990s, the rate of school-associated single-victim student homicides decreased significantly, whereas rates for school-associated homicides in which two or more students were killed (i.e., multiple-victim homicides) increased. Additional studies of such events during the same decade documented the rarity of lethal school-associated violence. To 1) update temporal trends in rates for school-associated student homicides during July 1992-June 2006 and 2) describe the epidemiologic characteristics of school-associated student homicides that occurred during July 1999-June 2006 (the period for which the most recent data are available), CDC analyzed data from the School-Associated Violent Death (SAVD) study. This report describes the results of that analysis, which indicated that rates of school-associated student homicides decreased during the overall period, July 1992-June 2006, but stabilized during July 1999-June 2006, when 116 students were killed in 109 school-associated homicide events. Although school-associated student homicides are rare and represent approximately 1% of homicides that occur among school-age youths, schools should expand use of comprehensive measures to prevent behaviors that often precede fatal violence. In addition, comprehensive approaches that address risk factors and protective risk factors for violence at the individual, family, school, and community levels will help address violence both on and off school grounds.     

School-associated suicides--United States, 1994-1999

During 1994-1999, at least 126 students carried out a homicide or suicide that was associated with a private or public school in the United States. Although previous research has described students who commit school-associated homicides, little is known about student victims of suicide. To describe the psychosocial and behavioral characteristics of school-associated suicide victims, CDC analyzed data from school and police officials. The results of that analysis indicated that, among the 126 students who carried out school-associated homicides or suicides, 28 (22%) died by suicide, including eight who intentionally injured someone else immediately before killing themselves. Two (7%) of the suicide victims were reported for fighting and four (14%) for disobedient behavior in the year preceding their deaths; none were associated with a gang. However, potential indicators of suicide risk such as expressions of suicidal thoughts, recent social stressors, and substance use were common among the victims. These findings underscore the need for school staff to learn to recognize and respond to chronic and situational risk factors for suicide.     

Firearm availability and suicide, homicide, and unintentional firearm deaths among women

Context In the United States, more than 45,000 women died from gun violence over the last decade. Objective To determine whether measures of firearm availability are related to rates of suicide, homicide, and unintentional firearm deaths among women in the United States. Design Pooled cross-sectional time series data on suicide, homicide, and unintentional firearm deaths (1988–1997) were used to estimate the association between the rate of violent death among women and four proxies of firearm availability. Two proxies came from survey reports of household firearm ownership rates; two were derived from mortality statistics. Setting United States, 1988–1997. Results The increased rate of suicide and homicide in states with high gun levels was accounted for primarily by significantly elevated firearm suicide and firearm homicide rates. Unintentional firearm death rates were also increased in states with more guns. At the regional level, qualitatively similar results were obtained. Conclusion Between 1988 and 1997, the suicide, homicide, and unintentional firearm death rates among women were disproportionately higher in states where guns were more prevalent. The elevated rates of violent death in states with more guns was not entirely explained by a state’s poverty or urbanization and was driven primarily by lethal firearm violence, not by lethal nonfirearm violence.     

Suicide attempts and physical fighting among high school students--United States, 2001

Violence is a major cause of morbidity and mortality, particularly among youths. In the United States, homicide and suicide are the second and third leading causes of death, respectively, for persons aged 13-19 years. Although suicide commonly is associated with anxiety, depression, and social withdrawal, research suggests a link between violent behaviors directed at oneself (i.e., suicidal behaviors) and violent behaviors directed at others among adolescents. Certain students who engage in extreme forms of violence, such as school shootings, exhibit suicidal ideation or behavior before or during the attack. However, suicidal behavior also might be associated with involvement in less extreme forms of violent behaviors, such as physical fighting, which might be a risk factor for more severe forms of violence. To characterize any potential association between suicide attempts and fighting, CDC analyzed self-reported 2001 data from a nationally representative sample of high school students in the United States. The results of that analysis indicated that students who reported attempting suicide during the preceding 12 months were nearly four times more likely also to have reported fighting than those who reported not attempting suicide. Prevention programs that seek to reduce both suicidal and violent behaviors are needed. Because prevalence of this association was determined to be highest in the 9th grade, these efforts might be most effective if implemented before students reach high school.     

Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample

OBJECTIVE: To estimate the protective effect of storing firearms locked or unloaded, or both, on the risk of suicide by firearms among people with relatively low intention to die. DESIGN AND SETTING: Cross sectional survey. The 1993 National Mortality Followback Survey of 22 957 deaths in the United States, representing 2.2 million people, conducted by the National Center for Health Statistics. PARTICIPANTS: Decedent's next of kin answered questions regarding various aspects of decedent's life to supplement information from death certificates. MAIN RESULTS: Compared with decedents who stored their firearm unlocked or loaded, those who stored their firearms locked or unloaded, or both, were less likely to commit suicide by firearms (locked: OR = 0.39, 95% CI = 0.24 to 0.66; unloaded OR = 0.30, 95% CI = 0.18 to 0.49). CONCLUSIONS: This study further supports the utility of devices and practices intended to reduce the likelihood of unauthorised or impulsive use of firearms.     

Patterns of gun deaths across US counties 1999–2013

PurposeWe examined the socio-demographic distribution of gun deaths across 3143 counties in 50 United States’ states to understand the spatial patterns and correlates of high and low gun deaths.MethodsWe used aggregate counts of gun deaths and population in all counties from 1999 to 2013 from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER). We characterized four levels of gun violence, as distinct levels of gun death rates of relatively safe, unsafe, violent, and extremely violent counties, based on quartiles of 15-year county-specific gun death rates per 100,000 and used negative binomial regression models allowing clustering by state to calculate incidence rate ratios and 95% confidence intervals (95% CIs).ResultsMost states had at least one violent or extremely violent county. Extremely violent gun counties were mostly rural, poor, predominantly minority, had high unemployment rate and homicide rate. Overall, homicide rate was significantly associated with gun deaths (incidence rate ratios = 1.08, 95% CI = 1.06–1.09). In relatively safe counties, this risk was 1.09 (95% CI = 1.05–1.13) and in extremely violent gun counties was 1.03 (95% CI = 1.03–1.04).ConclusionsThere are broad differences in gun death rates across the United States representing different levels of gun death rates in each state with distinct socio-demographic profiles.     

Fatal occupational injury rates: Quebec, 1981 through 1988.

OBJECTIVES. The purpose of the study was to estimate the death rates from occupational injuries in the province of Quebec for the period 1981 through 1988. METHODS. Worker's compensation files were used to ascertain numbers of deaths, which were used as the numerators in figuring the rates (it was estimated that these files reported 83% of the true number of deaths among men). Annual average estimates of the labor force were used as denominators. RESULTS. From 1981 through 1988, compensation was awarded for 1227 fatal work injuries. Among men (96% of the victims), rates declined from 1981 to 1988 (from 12.7 to 8.1 per 100,000); women's rates were stable (< or = 1.0 per 100,000). Compared with men, women had excess mortality from violent acts. Motor vehicle crashes accounted for 36% of all fatal injuries in 1984 and 1985 and declined thereafter. Fatal injury rates in forestry and mining rose to a 1987 maximum of 67.6 per 100,000. The construction sector had the largest number of deaths, despite a decline in rates from 1981 to 1988 (from 27.8 to 15.9 per 100,000). CONCLUSIONS. Except for construction and agriculture, reported fatal occupational injury rates in Quebec were similar to those in the United States. Motor vehicle crashes, falls, violent acts, and farming-related injuries were the most frequent causes of death.     

Heat-related mortality--Arizona, 1993-2002, and United States, 1979-2002

Hyperthermia is the elevation of body temperature resulting from the body's inability to dissipate heat. Continued exposure to ambient heat close to body temperature (98.6 degrees F [37.0 degrees C]) contributes to a substantial number of deaths from hyperthermia, especially among elderly persons. To assess the health risk from hyperthermia, Arizona health practitioners and CDC researched cases of heat-related death and illness in Arizona, used U.S. death certificate data to summarize trends in heat-related deaths, and compared age-specific, heat-related death rates in Arizona with those in the United States overall. Findings indicated that, during 1979-2002, a total of 4,780 heat-related deaths in the United States were attributable to weather conditions and that, during 1993-2002, the incidence of such deaths was three to seven times greater in Arizona than in the United States overall. Public health agencies in communities affected by periods of extreme heat should educate populations at risk (e.g., persons aged > or = 65 years) and consider designing and implementing location-specific heat response plans (HRPs).     

Diabetes-related mortality among Mexican Americans, Puerto Ricans, and Cuban Americans in the United States.

OBJECTIVES: Hispanics are the most rapidly growing minority group in the United States, and Mexican Americans, Puerto Ricans and Cuban Americans are the three largest Hispanic subgroups. Among Hispanics, type 2 diabetes is the fifth leading cause of death. This paper examines diabetes-related mortality in Mexican Americans, Puerto Ricans, and Cuban Americans over 35 years of age in the United States during 1996 and 1997. METHODS: Using data from the National Vital Statistics System and the 1990 and 2000 censuses, we calculated age-adjusted and age-specific diabetes-related death rates for Mexican Americans, Puerto Ricans, and Cuban Americans over 35 years of age. Diabetes-related deaths were determined to be any death for which diabetes was coded as either the underlying or contributing cause of death. RESULTS: The diabetes-related mortality rate for Mexican Americans (251 per 100,000) and Puerto Ricans (204 deaths per 100,000) was twice as high as the diabetes-related mortality rate for Cuban Americans (101 deaths per 100,000). Cuban American decedents had the highest proportion of deaths with diabetes coded as the underlying cause of death (44%). After diabetes, heart disease (31%) followed by cancer (8%) and stroke (6%) were the most frequent primary underlying causes of diabetes-related deaths in all three ethnic groups. CONCLUSION: Our analyses of these data demonstrate that diabetes-related mortality differed among Mexican Americans, Puerto Ricans and Cuban Americans more than 35 years of age in the United States in 1996 and 1997. Socioeconomic factors such as low educational attainment and low income may be factors that contributed to the disparities in these mortality rates for different subgroups. Further research is needed to update these findings and to investigate explanatory risk factors. Diversity among Hispanic subgroups has persisted in recent years and should be considered when health policies and services targeted at these populations are developed.     

Homicides and suicides--National Violent Death Reporting System, United States, 2003-2004

Violent deaths claimed 49,639 lives in the United States during 2003, and the prevention of violent deaths is an integral part of the public health agenda. In 2003, CDC launched the National Violent Death Reporting System (NVDRS) to provide detailed information on the circumstances of violent deaths. The system can be used to develop and evaluate prevention policies, programs, and strategies at the national, state, and local levels. This report describes the analysis of violent deaths from seven states that participated in NVDRS in 2003, plus six additional states that participated in 2004. Homicide circumstance information revealed that most victims knew the suspects involved and that intimate partner conflicts continued to be among the most important contributing factors. Suicide circumstance information indicated that mental health disorders and intimate partner problems had important roles. These findings underscore the value of NVDRS data for effective planning and targeting of violence-prevention programs.     

Mortality differentials among persons born in Cuba, Mexico, and Puerto Rico residing in the United States, 1979-81.

This paper examines the mortality experience in 1979-81 of three first generation Hispanic subpopulations in the United States, as defined by area of birth (Cuba, Mexico, Puerto Rico). Numerators were derived from National Center for Health Statistics (NCHS) mortality tapes, which included codes for selected places of birth appearing on the death certificate. Denominators were based on decennial census data for these migrant populations from the 1980 census. Generally, mortality is relatively high among Cuban-born, Mexican-born and Puerto Rican-born adolescents and young adults, particularly males, largely due to violent deaths. Aged migrants, despite their disadvantaged socioeconomic status, exhibit relatively low death rates from heart disease and cancer.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.     

The incidence of defensive firearm use by US crime victims, 1987 through 1990.

It is well known that many crimes in the United States are committed with firearms. Less adequately documented is the frequency with which victims use guns in self-defense. We used National Crime Victimization Survey data to examine incidents where victims employed guns against offenders. Between 1987 and 1990 there were an estimated 258,460 incidents of firearm defense, an annual mean of 64,615. Victims used firearms in 0.18% of all crimes recorded by the survey and in 0.83% of violent offenses. Firearm self-defense is rare compared with gun crimes.     

Alcohol misuse,firearm violence perpetration,and public policy in the United States

ObjectiveFirearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings.MethodNarrative review augmented by new tabulations of publicly-available data.ResultsAcute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence.ConclusionThe evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated.     

The effect of legal drinking age on fatal injuries of adolescents and young adults.

This study examined the effect of legal drinking age (LDA) on fatal injuries in persons aged 15 to 24 years in the United States between 1979 and 1984. Effects on pre-LDA teens, adolescents targeted by LDA, initiation at LDA, and post-LDA drinking experience were assessed. A higher LDA was also associated with reduced death rates for motor vehicle drivers, pedestrians, unintentional injuries excluding motor vehicle injuries, and suicide. An initiation effect on homicides was identified. Reductions in injury deaths related to drinking experience were not found. In general, a higher LDA reduced deaths among adolescents and young adults for various categories of violent death.     

Lightning-associated injuries and deaths among military personnel--United States, 1998-2001

After flooding, lightning is the second leading cause of weather-related death in the United States; approximately 300 injuries and 100 deaths are associated annually with lightning strikes in the United States. To characterize lightning-associated injuries and deaths among U.S. Armed Forces personnel, the U.S. Army and CDC analyzed data from the Defense Medical Surveillance System (DMSS). This that the highest lightning-related injury rates during 1998-2001 occurred among male U.S. military members who were aged <40 years, single, with a high school education or less, stationed near the Gulf of Mexico or the East Coast, and in the U.S. Army. The findings suggest that the risk for lightning-associated injury depends primarily on the frequency, timing, duration, and nature of outdoor exposure to thunderstorms. Military personnel should be aware of severe weather onset and take reasonable precautions to protect themselves and their companions from exposure to lightning.     

Gun utopias? Firearm access and ownership in Israel and Switzerland

The 2011 attempted assassination of a US representative renewed the national gun control debate. Gun advocates claim mass-casualty events are mitigated and deterred with three policies: (a) permissive gun laws, (b) widespread gun ownership, (c) and encouragement of armed civilians who can intercept shooters. They cite Switzerland and Israel as exemplars. We evaluate these claims with analysis of International Crime Victimization Survey (ICVS) data and translation of laws and original source material. Swiss and Israeli laws limit firearm ownership and require permit renewal one to four times annually. ICVS analysis finds the United States has more firearms per capita and per household than either country. Switzerland and Israel curtail off-duty soldiers' firearm access to prevent firearm deaths. Suicide among soldiers decreased by 40 per cent after the Israeli army's 2006 reforms. Compared with the United States, Switzerland and Israel have lower gun ownership and stricter gun laws, and their policies discourage personal gun ownership.     

Violent deaths in the United States, 1900–1975: Relationships between suicide,homicide and accidental deaths

Time trends are presented for suicide, homicide and accident mortality rates in the United States, 1900–1975. These data suggest that national mortality rates for suicide, homicide and motor- vehicle accidents tend to be parallel over time. Non-motor-vehicle accidents, while showing some fluctuations similar to those of other forms of violent deaths, manifest a more general decrease throughout the century. In addition, suicide rates tend to be significantly correlated over time with homicide, motor- vehicle and non-motor-vehicle accident death rates for most race and sex combinations. These results need to be viewed with caution due to the methodologic problems inherent in using national mortality data. However, the findings raise serious questions about the traditional understanding of the relationships between the various forms of violent death in populations; in particular, the popular view that suicide and homicide are inversely related in populations is questioned. The explanatory usefulness of conceptualizing violent deaths as reflecting self-destructive tendencies is discussed.     

Deaths due to unknown foodborne agents

This study reviews the available evidence on unknown pathogenic agents transmitted in food and examines the methods that have been used to estimate that such agents cause 3,400 deaths per year in the United States. The estimate of deaths was derived from hospital discharge and death certificate data on deaths attributed to gastroenteritis of unknown cause. Fatal illnesses due to unknown foodborne agents do not always involve gastroenteritis, and gastroenteritis may not be accurately diagnosed or reported on hospital charts or death certificates. The death estimate consequently omitted deaths from unknown foodborne agents that do not cause gastroenteritis and likely overstated the number of deaths from agents that cause gastroenteritis. Although the number of deaths from unknown foodborne agents is uncertain, the possible economic cost of these deaths is so large that increased efforts to identify the causal agents are warranted.