Violent Deaths in 32 States, 2016: Findings from CDC's Reporting System

About 65,000 people died from violence-related injuries in the United States in 2016. Most were not homicides. In the 32 states that reported to CDC's National Violent Death Reporting System (NVDRS) that year, 62% of the 41,466 violent deaths were suicides.

NVDRS is unusual in how much it knows about each death. It combines death certificates, coroner and medical examiner reports and law enforcement reports — plus, in some states, child fatality reviews, crime lab data and other sources — and links related deaths, such as a homicide followed by the suspect's suicide, into a single incident. That makes it the first system to record the circumstances that led up to violent deaths.

The toll

"Legal intervention" means a death caused by law enforcement or others with legal authority to use deadly force, acting in the line of duty, excluding executions. It is an ICD-10 classification and says nothing about whether the death was lawful.

Suicide

• Who: the rate for males (24.8 per 100,000) was 3.5 times that for females (7.0). The highest rates were among American Indian/Alaska Native males (42.8) and White males (29.7), and among men 85 and older (44.5). Among women, the rate peaked at ages 45–54 (10.4).
• How: firearms in 49.4% of suicides, hanging, strangulation or suffocation in 27.8%, poisoning in 14.4%. Men most often used firearms (55.3%); among women, poisoning (32.9%), firearms (29.1%) and hanging (28.2%) were about equally common. Three in four happened at home.
• What came before: a crisis in the previous or upcoming two weeks (31.2%), intimate partner problems (28.1%), physical health problems (22.3%) and arguments (16.2%); alcohol problems in 17.8% and other substance problems in 16.8%. A third (33.6%) left a note, 32.6% had a history of suicidal thoughts or plans, 20.3% had attempted before, and 23.5% had told someone of their intent — most often a current or former partner.
• Mental health: 64.3% of women and 44.3% of men had a diagnosed mental health problem; 40.2% of women and 23.0% of men were in treatment when they died. Earlier NVDRS research found more than half of people who die by suicide had no known mental health condition — so relationship problems and crises are prevention opportunities too.

Homicide

• Who: homicide rates were highest for males, infants under 1, and people aged 15–44. The rate for Black males, 41.5 per 100,000, was 2.7 times that for American Indian/Alaska Native males and about 14 times that for White males. Infants were killed at 7.0 per 100,000 — 3.3 times the rate for children aged 1–4.
• How and where: firearms were used in 73.8% of homicides. Women were more often killed at home (69.3%, against 41.6% of men); men more often on a street or highway (28.2% against 8.9%).
• By whom: where the relationship was known, half of women (50.1%) were killed by a current or former intimate partner, compared with 7.5% of men; men were most often killed by an acquaintance or friend (35.2%).
• Why: intimate partner violence was involved in 43.2% of homicides of women; an argument or conflict in 33.1% of homicides of men and 28.7% of women. Fights, drugs and gangs figured more often in men's deaths; caretaker abuse or neglect in 10.3% of women's.

Other deaths

• Legal intervention: 95.5% of those killed were male, and 96.1% of deaths involved firearms. Rates were highest among men aged 20–44, and the rate for Black males was three times that for White males. The most common circumstances were alleged criminal activity in progress, the victim's reported use of a weapon, mental health or substance problems, an argument, or a crisis.
• Unintentional firearm deaths: 86.4% of those who died were male, and the deaths were more frequent among White people and people aged 15–24. About half (51.2%) were self-inflicted and 35.3% were inflicted by someone else. Most happened at home (73.9%) and involved handguns (63.1%), most often while someone was playing with a gun, accidentally pulled the trigger or thought it was unloaded.
• Undetermined intent: 72.2% were poisonings. Of those tested for opioids, 79.2% were positive; whether these were accidental overdoses or suicides is unknown.

Young people

Suicide was the second leading cause of death for people aged 10–24 in 2016. From 1999 to 2016, the suicide rate rose about 48% among 10- to 17-year-olds (3.1 to 4.6 per 100,000) and 27.1% among 18- to 24-year-olds (11.8 to 15.0). NVDRS recorded 3,655 suicides in this age group in 2016.

Younger people who disclosed their intent most often told a friend; older ones most often told a partner.

What prevents violent death

CDC's technical packages set out evidence-based strategies for preventing child abuse and neglect, intimate partner violence, youth violence, sexual violence and suicide. Among them:

• Suicide: strengthen economic supports and access to suicide care, reduce access to lethal means for people at risk, promote connectedness, teach coping and problem-solving skills, identify and support people at risk, and prevent reattempts — through programs such as Sources of Strength, Youth Aware of Mental Health and Strengthening Families 10–14.
• Children: safe, stable, nurturing relationships and environments, economic support for families, positive-parenting norms, quality early care and education, and parenting skills.
• Intimate partner violence: screening and referral, support for survivors, engaging bystanders and men and boys, and teaching young people about healthy relationships before they date, as in the Safe Dates program.
• Homicide inequities: reducing systemic inequities — residential segregation, concentrated disadvantage, the stress of racism and limited access to education and jobs.

States already use NVDRS this way. Utah investigated why its youth suicide rate had more than doubled during 2011–2015 and found, among other things, that family conflict over restricting phones, tablets or games played a part in about 13% of cases with known circumstances. Rhode Island's findings on youth suicide and depression led to a program linking school crisis teams with emergency mental health clinicians. And Kansas's data informed the Kansas Youth Suicide Prevention Task Force.

Limits

The 32 states covered 58% of the U.S. population, so the data are not nationally representative; since 2019, NVDRS has covered all 50 states, the District of Columbia and Puerto Rico. Completeness depends on partnerships with coroners, medical examiners and police; toxicology testing varies; mental health details often come from family and friends; and records rarely capture protective factors.

If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.

Sources

Based on Allison Ertl, Kameron J. Sheats, Emiko Petrosky, Carter J. Betz, Keming Yuan and Katherine A. Fowler, "Surveillance for Violent Deaths — National Violent Death Reporting System, 32 States, 2016," MMWR Surveillance Summaries, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain. Data are available through CDC's WISQARS.