National Violent Death Reporting System: A History

1. The Illinois Violent Death Reporting System & The State Unintentional Drug Overdose Reporting SystemMarch 11, 2019Northwestern Neighborhood & Network Initiative (N3)Northwestern UniversitySuzanne McLone, MPHSenior EpidemiologistInjury Prevention & Research CenterSmith Child Health Research Outreach & Advocacy CenterAnn & Robert H. Lurie Children’s Hospital of Chicago

2. IVDRS and SUDORSCDC-funded surveillance systems to collect and link information on ‘Deaths of despair’

3. National Violent Death Reporting System: A History • Conception: 1999 Institute of Medicine Report recommends the creation of a national fatal intentional injury surveillance system • Early pilot: 1999 Six foundations start the National Violent Injury Statistics System (NVISS) in academic test tubes

4. National Violent Death Reporting System: A History • 2000 NVISS gets under way at 12 sites, mostly universities • 2000 Harvard and the Joyce Foundation convene an expert meeting that suggests the CDC direct a publicly funded system • 2000 CDC starts planning

5. National Violent Death Reporting System: A History • 2002 Congress’ 1st appropriation ($1.5 million) • CDC funds 6 of 17 applying states: • MA, MD, NJ, OR, SC, and VA • 2003 Congress’ 2nd appropriation • CDC funds 7 of 16 newly-applying states: • AK, CO, GA, NC, OK, RI and WI

6. National Violent Death Reporting System: A History • 2004 Congress’ 3rd appropriation • CDC funds additional 4 of 10 newly-applying states: • CA, KY, NM and UT • 2014 Federal funding increases by over $7 million – • $11.2 million total • Result of advocacy efforts at multiple levels and increased media attention on violent deaths in the United States • CDC expands to 32 states, including Illinois

7. National Violent Death Reporting System: A History • 2015 Federal funding increases by $4.7 million • CDC funds additional 10 sites – 8 states plus Puerto Rico and DC • 2016 Federal funding increases by over $7 million – • $23.6 million total • NVDRS is truly a national surveillance system – all 50 states plus Puerto Rico and DC Source: CDC FY 2017 Congressional Justification

8. National Violent Death Reporting System: In a Nutshell • NVDRS is a state-based surveillance system that links data to assist states in designing/implementing tailored violence prevention and intervention efforts. • Law enforcement, • Coroners and Medical Examiners, • Vital statistics, and • Crime laboratories • NVDRS is a funded project of the Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (CDC Injury Center) • All 50 states, plus Puerto Rico and DC • All but three housed in state/local health departments: AZ, IL, KY

9. Death certificates Coroner/ Medical Examiner Law Enforcement Illinois Violent Death Reporting System • IVDRS • 2005-2014: Funded by • Illinois Department of Public Health • The Joyce Foundation • Based on CDC’s NVDRS system • Shadow system • Uses CDC software and protocols • No CDC funding • Not included in WISQARS • 2005-2010 data • In 2014, Funded by CDC • Became one of 32 NVDRS sites • Will be included in WISQARS 2016 • 2015 data, pilot year • 2016+ data Linking Data to Save Lives!

10. Operational Definition of a Violent Death Cause of death = biological Manner of death = medicolegal IL cases are identified by manner of death (not IDC-10 codes): • Homicide • Suicide • Death of undetermined intent • Legal intervention • Accidental death due to firearm injury Not included: • Manner is of undetermined intent and COD is unknown • Fetal death • State executions • Acts of War

11. Examples of IDC-10 Codes that Define NVDRS Cases Death <1 yr after Injury Death >1 yr after Injury Underlying COD Intentional self harm X60-84 Y87.0 Assault X85-99, Y00-09 Y87.1 Undetermined intent Y10-34 Y87.2, Y89.9 Unintentional firearm W32-34 Y86 (firearms) Legal intervention Y35.0-Y35.4, Y35.6-Y35.7 Y89.0 Terrorism U01, U03 *U02

12. IVDRS Counties • 88% of all violent deaths in Illinois occur in 26 counties • The remaining 12% of violent deaths are distributed among 76 counties • 2015 was a pilot year, we collected data from 6 counties, which comprised 65% of violent deaths in Illinois* • 2016 and 2017, we collected data from 16 counties, which comprised 81% of violent deaths in Illinois* • * CDC Wonder, 2010

13. IVDRS is an Incident-Based System • Unlike most public health surveillance systems, IVDRS uses the incident as the unit of surveillance. • A single violent death (e.g., a suicide) constitutes an incident • Multiple people who are victims or suspects in violent deaths also constitute an incident if they are connected and the injuries occur within a 24-hour period. • This allows capture of causal relationships among deaths and description of the social relationships involved. • It still allows each death to be used as a unit of analysis (e.g., calculation of rates)

14. Location, location, location… • Location of victim’s death • County of death is used for case initiation • If we have an MOU with that county, we collect the information on that death • Location of victim’s residence • Location of fatal injury which led to victim’s death • Point of prevention!

15. Residence vs. Occurrent Deaths • Resident deaths are needed for population-based rates. • Occurrent deaths allow mapping of where violence is occurring, not where victims of violence live. • If a victim lives in one state and dies in another, and resident and occurrent states are both NVDRS states, the occurrent state is responsible for collecting the death.

16. IVDRS tabs/modules Child Fatality Review data is limited to DCFS wards in Illinois. Overdose: SUDORS data entered here Intimate Partner Violence

17. How YOU can get this data Handout is available

18. The Data Abstractors Angela Sandra Gemini Matt Michael Hillary Sarah Ali Claire Mauricio Uriah Raahi

19. Thank you!