Surveillance and Data Quality

1. The National Violent Death Reporting System (NVDRS) is already providing useful data

This essay provides many specific examples of new knowledge available from the NVDRS, some of which has already informed policy.

Barber, Catherine; Azrael, Deborah; Hemenway, David.  A truly national National Violent Death Reporting System.  Injury Prevention.  2013; 19(4):225-6.


2. A good national data system for violent death is crucial

A broadened reporting system, not only for firearms but for all violent deaths (all suicides and homicides) will provide more useful data, at only a small increased cost.  This article summarizes the need for such a surveillance system, and its status as of 2001.

Azrael, Deborah; Barber, Catherine; Mercy, James.  Linking data to save lives: Recent progress in establishing a National Violent Death Reporting System.  Harvard Health Policy Review.  2001; 2:38-42.


3. A violent death reporting system will be useful for policy evaluation

This article highlights the benefits of surveillance systems for various social issues (e.g., economics, crime, public health).  It shows how the additional information provided by a national violent death reporting system can be used for policy evaluation.

Azrael, Deborah; Barber, Catherine; Hemenway, David; Miller, Matthew.  “Data on violent injury.”  In: Jens Ludwig and Philip J. Cook, eds.  Evaluating Gun Policy: Effects on Crime and Violence.  Washington D.C.: Brookings Institution.  2003.


4. We describe the history of the creation of National Violent Death Reporting System

We describe the effort of many groups, which led to the creation of this data system.

Hemenway, David; Barber, Catherine W; Gallagher, Susan S; Azrael Deborah R.  Creating a national violent death reporting system: A successful beginning.  American Journal of Preventive Medicine.  2009; 37:68-71.


5. The vital statistics underestimates other-inflicted gun accidents

Do the vital statistics provide an accurate count of unintentional firearm deaths?  We compared the Supplemental Homicide Report data on “manslaughter by negligence,” which are considered to be accidents with the vital statistics data.  We found that only 23% of the negligence manslaughters were classified as accidents on the death certificates.  Official vital statistics data almost certainly undercount firearm accident deaths when the victim is shot by another person.

Barber, Catherine; Hemenway, David; Hochstadt, Jenny; Azrael, Deborah.  Underestimates of accidental firearm fatalities: Comparing Supplementary Homicide Report data with Vital Statistics.  Injury Prevention.  2002; 8:252-256.


6. For accidental gun deaths, NVDRS data are accurate, Vital Statistics are not

We carefully read all the circumstances of any death characterized as an unintentional firearm fatality by the state vital statistics registry (death certificate), the medical examiner or coroner, the police, or the National Violent Death Certificate (NVDRS) abstractor.  We found that the NVDRS data were extremely accurate but the Vital Statistics data were not.  The Vital Statistics data seriously under-report accidental deaths to children (many true accidents are reported as homicides) and over-report accidental deaths to adults (many homicides and suicides are reported as accidents).

Barber, Catherine; Hemenway, David.  Too many or too few unintentional firearm deaths in official U.S. mortality data?  Accident Analysis and Prevention.  2011; 43:724-31.


7. The best proxy measure of firearm prevalence is the percentage of suicides with guns

Various proxy measures for the prevalence of firearm ownership were compared with surveys-based estimates.  One proxy, the percentage of suicides with a firearm, performed consistently better than other measures in cross-sectional comparisons.

Azrael, Deborah; Cook, Philip J; Miller, Matthew.  State and local prevalence of firearms ownership: Measurement, structure and trends.  Journal of Quantitative Criminology.  2004; 20:43-62.  Also see National Bureau of Economic Research Working Paper #8570.


8. CDC’s WISQARS dramatically underestimates the costs of street gun violence

This commentary emphasizes that cost of injury estimates that focus on medical costs and productivity losses of the victims (e.g., WISQARS) dramatically underestimate the costs of street gun crime.  Costs of street gun crime also include costs to the shooters family, criminal justice costs, trauma of witnesses, the costs of avoidance (e.g., children not being able to go out and play), the likelihood of retaliation, and the destruction of neighborhoods.

Hemenway, David.  Measuring the cost of injury: Underestimating the costs of street violence.  Injury Prevention.  2011; 17(5):289-90.


9. Vital Statistics and police reports undercount homicides by police

Homicides by police are vastly undercounted by police reports and by Vital Statistics.  The National Violent Death Reporting System will be an excellent source for good data on police homicides but all states need to be part of the system.

Police killings are constantly in the news.  This article provides another endorsement for the NVDRS, and shows that the U.S. doesn’t need to create another data system for the sole purpose of tracking police homicide.

Barber C, Azrael D, Cohen A, Miller M, Thymes D, Wang D, Hemenway D.  Homicides by police: Comparing counts from the National Violent Death Reporting System, Vital Statistics, and Supplementary Homicide Reports.  Journal of Public Health.  2016; 106(5):922-7.


10. Useful results have already emerged from the NVDRS

This article provides examples of some of the useful and important findings that have already come out of the National Violent Death Reporting System data, and how states have used their systems to promote effective policy and programs.

The article makes the best case for the importance of NVDRS and why it should be expanded to cover the entire United States.

Barber C, Azrael D, Hemenway D.  A truly National Violent Death Reporting System.  Injury Prevention.  2013 Aug; 19(4):225-6.