Validating the National Violent Death Reporting System as a Source of Data on Fatal Shootings of Civilians by Law Enforcement Officers

Officer-Involved Killings of Unarmed Black People and Racial Disparities in Sleep Health

Importance

Racial disparities in sleep health may mediate the broader health outcomes of structural racism.

Objective

To assess changes in sleep duration in the Black population after officer-involved killings of unarmed Black people, a cardinal manifestation of structural racism.

Design, Setting, and Participants

Two distinct difference-in-differences analyses examined the changes in sleep duration for the US non-Hispanic Black (hereafter, Black) population before vs after exposure to officer-involved killings of unarmed Black people, using data from adult respondents in the US Behavioral Risk Factor Surveillance Survey (BRFSS; 2013, 2014, 2016, and 2018) and the American Time Use Survey (ATUS; 2013-2019) with data on officer-involved killings from the Mapping Police Violence database. Data analyses were conducted between September 24, 2021, and September 12, 2023.

Exposures

Occurrence of any police killing of an unarmed Black person in the state, county, or commuting zone of the survey respondent's residence in each of the four 90-day periods prior to interview, or occurence of a highly public, nationally prominent police killing of an unarmed Black person anywhere in the US during the 90 days prior to interview.

Main Outcomes and Measures

Self-reported total sleep duration (hours), short sleep (<7 hours), and very short sleep (<6 hours).

Results

Data from 181 865 Black and 1 799 757 White respondents in the BRFSS and 9858 Black and 46 532 White respondents in the ATUS were analyzed. In the larger BRFSS, the majority of Black respondents were between the ages of 35 and 64 (99 014 [weighted 51.4%]), women (115 731 [weighted 54.1%]), and college educated (100 434 [weighted 52.3%]). Black respondents in the BRFSS reported short sleep duration at a rate of 45.9%, while White respondents reported it at a rate of 32.6%; for very short sleep, the corresponding values were 18.4% vs 10.4%, respectively. Statistically significant increases in the probability of short sleep and very short sleep were found among Black respondents when officers killed an unarmed Black person in their state of residence during the first two 90-day periods prior to interview. Magnitudes were larger in models using exposure to a nationally prominent police killing occurring anywhere in the US. Estimates were equivalent to 7% to 16% of the sample disparity between Black and White individuals in short sleep and 13% to 30% of the disparity in very short sleep.

Conclusions and Relevance

Sleep health among Black adults worsened after exposure to officer-involved killings of unarmed Black individuals. These empirical findings underscore the role of structural racism in shaping racial disparities in sleep health outcomes.

National Burden of Injury and Deaths From Shootings by Police in the United States, 2015‒2020

Objectives. To describe all-outcome injurious shootings by police and compare characteristics of fatal versus nonfatal injurious shootings nationally. Methods. From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by US police, identified from Gun Violence Archive. We estimated injury frequency, case fatality rates, and relative odds of death by incident and victim characteristics. Results. A total of 1769 people were injured annually in shootings by police, 55% fatally. When a shooting injury occurred, odds of fatality were 46% higher following dispatched responses than police-initiated responses. Injuries associated with physically threatening or threat-making behaviors, behavioral health needs, and well-being checks were most frequently fatal. Relative to White victims, Black victims were overrepresented but had 35% lower odds of fatal injury when shot. Conclusions. This first multiyear, nationwide analysis of injurious shootings by US police suggests that injury disparities are underestimated by fatal shootings alone. Nonpolicing responses to social needs may prevent future injuries. Public Health Implications. We call for enhanced reporting systems, comprehensive evaluation of emerging reforms, and targeted investment in social services for equitable injury prevention. (Am J Public Health. 2024;114(4):387-397. https://doi.org/10.2105/AJPH.2023.307560).

Artificial Intelligence and the National Violent Death Reporting System: A Rapid Review

As the awareness on violent deaths from guns, drugs, and suicides emerges as a public health crisis in the United States, attempts to prevent injury and mortality through nursing research are critical. The National Violent Death Reporting System provides public health surveillance of US violent deaths; however, understanding the National Violent Death Reporting System's research utility is limited. The purpose of our rapid review of the 2019-2023 literature was to understand to what extent artificial intelligence methods are being used with the National Violent Death Reporting System. We identified 16 National Violent Death Reporting System artificial intelligence studies, with more than half published after 2020. The text-rich content of National Violent Death Reporting System enabled researchers to center their artificial intelligence approaches mostly on natural language processing (50%) or natural language processing and machine learning (37%). Significant heterogeneity in approaches, techniques, and processes was noted across the studies, with critical methods information often lacking. The aims and focus of National Violent Death Reporting System studies were homogeneous and mostly examined suicide among nurses and older adults. Our findings suggested that artificial intelligence is a promising approach to the National Violent Death Reporting System data with significant untapped potential in its use. Artificial intelligence may prove to be a powerful tool enabling nursing scholars and practitioners to reduce the number of preventable, violent deaths.

Association between outdoor temperature and fatal police shootings in the United States, 2015-2021

Background

Here, we investigate the association between outdoor temperature and fatal police shootings in the United States between 2015 and 2021.

Methods

We conducted a time-stratified case-crossover study. Data on fatal police shootings were from the Washington Post's Fatal Force database and temperature data were from Daymet.

Results

A 5°C increase in maximum same-day temperature was associated with a 1.033 (95% CI = 1.002, 1.065) increased odds of a fatal police shooting. In stratified analyses, the strongest associations were observed in victims who were armed (OR, 1.052 [95% CI = 1.017, 1.088), White (OR, 1.052 [95% CI = 1.006, 1.100), or aged 45+ (OR, 1.110 [95% CI = 1.044, 1.181]). In additional subgroup analyses, relative risks were also generally higher among those who were armed.

Conclusions

There is evidence of an association between outdoor temperature and fatal police shootings in the United States, particularly when the victims were reported as armed. This study cannot determine if the associations are a result of any specific causes (e.g., increased police aggression or other factors).

Firearm availability and police shootings of citizens: a city level analysis of fatal and injurious shootings in California and Florida

BACKGROUND

A growing body of research has found a link between firearm availability and police shootings of citizens across place. The problem, however, is that the previous studies on the topic tend to suffer from several limitations: a near exclusive focus on citizen fatalities, units of analysis at the state or county levels, and a variety of proxy measures tapping into community-level firearm access. The current study set out to address these issues by examining the relationship between different forms of firearm availability and both fatal and nonfatal injurious police shootings of citizens at the city level.

METHODS

More specifically, it merged The Trace's "Missing Pieces" measures of guns reported lost and stolen to police as well as licensed firearms dealers across jurisdictions from the Bureau of Alcohol, Tobacco, Firearms, and Explosives as proxies for firearm availability with data on police shootings of citizens in California and Florida from California's URSUS system and the Tampa Bay Times' "Why Cops Shoot" database, respectively. Negative binomial regression analyses were performed on a sample of 253 cities across the two states and a sub-sample of cities with licensed firearms dealers.

RESULTS

Findings uncovered a small positive association between rates of federally licensed guns stores and the number citizens shot by police as well as police shooting incidents while controlling for several community-level measures (e.g., concentrated disadvantage, gun homicide rates). Rates of guns lost or reported stolen were generally not significantly associated with the outcome measures in the multivariate models.

CONCLUSIONS

Firearm availability is a significant correlate of police shootings. Pooled counts of both citizens shot by police and police shooting incidents are heightened in jurisdictions with higher rates of licensed gun dealers, which may be due to the fact that all firearms sold in the USA first make their way to the public through these mechanisms. Such licensed gun dealers must be appropriately monitored and audited to reduce illicit behavior and prevent firearms from making their way into secondary markets. Addressing access to firearms can be meaningful for a host of gun-related morbidity and mortality outcomes, including police shootings of citizens.

Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada

Importance

Police shootings can cause serious acute injury, and knowledge of subsequent health outcomes may inform interventions to improve care.

Objective

To analyze long-term health care costs among survivors of police shootings compared with those surviving nonfirearm police enforcement injuries using a retrospective design.

Design, Setting, and Participants

This population-based cohort analysis identified adults (age ≥16 years) who were injured by police and required emergency medical care between April 1, 2002, and March 31, 2022, in Ontario, Canada.

Exposure

Police shootings compared with other mechanisms of injury involving police.

Main Outcomes and Measures

Long-term health care costs determined using a validated costing algorithm. Secondary outcomes included short-term mortality, acute care treatments, and rates of subsequent disability.

Results

Over the study, 13 545 adults were injured from police enforcement (mean [SD] age, 35 [12] years; 11 637 males [86%]). A total of 13 520 individuals survived acute injury, and 8755 had long-term financial data available (88 surviving firearm injury, 8667 surviving nonfirearm injury). Patients surviving firearm injury had 3 times greater health care costs per year (CAD$16 223 vs CAD$5412; mean increase, CAD$9967; 95% CI, 6697-13 237; US $11 982 vs US $3997; mean increase, US $7361; 95% CI, 4946-9776; P < .001). Greater costs after a firearm injury were not explained by baseline costs and primarily reflected increased psychiatric care. Other characteristics associated with increased long-term health care costs included prior mental illness and a substance use diagnosis.

Conclusions and Relevance

In this longitudinal cohort study of long-term health care costs, patients surviving a police shooting had substantial health care costs compared with those injured from other forms of police enforcement. Costs primarily reflected psychiatric care and suggest the need to prioritize early recognition and prevention.

Lethal use of force surveillance: practical considerations for open-source database linkage

Currently, there remains no reliable and timely government tracking in the USA of deaths caused by law enforcement. Federal efforts to track these events are insufficient, generally missing as many as half of community deaths that occur annually because of law enforcement's lethal use of force. The dearth of accurate data on these events limits the ability to accurately quantify their burden and effectively identify opportunities for intervention and policy change. The most reliable data sources on law enforcement related deaths among community members in the USA are publicly run (such as those run by the Washington Post and The Guardian newspapers) or crowdsourced systems, such as Fatal Encounters and Mapping Police Violence, which draw on both traditional and non-traditional sources of reporting and provide open-source access to users. We used successive deterministic and probabilistic linkage to merge these four databases. After exclusions, we found a total of 6333 deaths identified from 2013 to 2017. While most cases were identified by multiple databases, each database also found unique cases during their years of operation. The methodology described here emphasises the importance of these non-traditional data sources and can serve as a helpful resource to improve data accessibility and timeliness for public health agencies and others seeking to expand their study, understanding and response to this growing public health crisis.

Research utility and limitations of textual data in the National Violent Death Reporting System: a scoping review and recommendations

BACKGROUND

Many studies of injury deaths rely on mortality data that contain limited contextual information about decedents. The National Violent Death Reporting System (NVDRS) is unique among such data systems in that each observation includes both quantitative variables and qualitative texts (called "narratives") abstracted from original source documents. These narratives provide rich data regarding salient circumstances that can be used to inform prevention efforts. This review provides a comprehensive summary of peer-reviewed research using NVDRS narratives over the past 20 years, including the limitations of these texts and provides recommendations on utilizing and improving narrative quality for researchers and practitioners.

MAIN BODY

Studies that used narratives to examine deaths related to suicide, homicide, undetermined intent, accidental firearm, or legal intervention were identified by a title/abstract screening, followed by a full-text review. The search was conducted on English-language, peer-reviewed literature and government reports published from 2002 to 2022 in PubMed, PsycInfo, Scopus, and Google Scholar. Abstracted elements focused on the methodologies used to analyze the narratives, including approaches to explore potential biases in these texts. Articles were abstracted independently by two reviewers, with disagreements resolved through consensus discussion. During the 20-year period, 111 articles used narratives. Two-thirds studied suicide (n = 48, 43%) and homicides (n = 25, 23%). Most studies analyzed the narratives using manual review (n = 81, 73%) and keyword searches (n = 9, 8%), with only 6 (5%) using machine learning tools. Narratives were mainly used for case finding (n = 49, 44%) and characterization of circumstances around deaths (n = 38, 34%). Common challenges included variability in the narratives and lack of relevant circumstantial details for case characterization.

CONCLUSION

Although the use of narratives has increased over time, these efforts would be enhanced by detailed abstraction of circumstances with greater salience to injury research and prevention. Moreover, researchers and practitioners would benefit from guidance on integrating narratives with quantitative variables and standardized approaches to address variability in the completeness and length of narratives. Such efforts will increase the reliability of findings and set the stage for more widespread applications of data science methods to these texts.

Do Sheriff-Coroners Underreport Officer-Involved Homicides?

Introduction

In the United States, each state sets its own standards for its death investigation system. These may require independent medical examiners and coroners or allow for the sheriff to assume the role of coroner. Motivated by the well-established fact that counts of officer-involved homicides in official data sets grossly undercount the number of these incidents, we examine the possibility that different death investigation systems may lead to different death classification outcomes.

Methods

To examine the potential differences in officer-involved homicide underreporting by presence of sheriff-coroner and violent death type (gunshot, intentional use of force, pursuit, or other vehicle accident), we compare ratios of incidents from both the Federal Bureau of Investigation's Supplementary Homicide Reports and the restricted Multiple-Cause of Death files from the National Vital Statistics System to the Fatal Encounters data across coroner contexts in California between 2000 and 2018; we quantify differences descriptively and examine bivariate tests of means.

Results

We find significantly greater underreporting of officer-involved deaths in sheriff-coroner counties in both official data sets for all incidents compared with non-sheriff-coroner counties, independently of the period considered. These underreporting differences in the National Vital Statistics System are robust to restricting to gunshot and intentional use of force deaths, the type of incident expected to be less prone to misclassification in that data set.

Conclusions

Officer-involved death underreporting in sheriff-coroner counties necessitates further scrutiny. Disparities in officer-involved death reporting suggest political pressure may play a role in classifying deaths.

The emerging infrastructure of US firearms injury data

For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign "external cause of injury" codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.) Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments. We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police.

Defensive gun use: What can we learn from news reports?

Background

In the past decade, most people who buy and own guns are doing so for self-defense. Yet little is known about actual defensive gun use in the USA.

Methods

To discover what information newspaper articles and local news reports might add, we read the news reports of defensive use incidents assembled by the Gun Violence Archive. We examined a sample of more than a quarter of the incidents from 2019, the last year before the pandemic. We examined all cases from four months—January, April, July, and October. We created a typology of defensive gun use incidents.

Results

Of 418 incidents, in about half, the perpetrator was armed with a firearm. In almost 90% of the cases, the victim fired their firearm—315 perpetrators were shot and about half of them died. The average number of perpetrators shot per incident was 0.75; the average number of victims shot was 0.25. We estimate that in 2019 fewer than 600 potential perpetrators were killed in defensive gun use incidents that made the news. Among the thirteen categories of shooting were drug-related (4% of incidents), gang-like combat (6%), romantic partner disputes (11%), escalating arguments (13%), store robberies (9%), street robberies (5%), unoccupied vehicle theft (5%), unarmed burglaries (7%), home invasions (20%), and miscellaneous (6%).

Conclusion

We believe the Gun Violence Archive dataset includes the large majority of news reports of defensive gun use—and especially those in which the perpetrator is shot and dies. Some of the strengths of using news reports as a data source are that we can be certain that the incident occurred, and the reports provide us with a story behind the incident, one usually vetted in part by the police with occasional input from the victims, perpetrator, family, witnesses, or neighbors. Defensive gun use situations are quite diverse, and among the various categories of defensive gun use, a higher percentage of incidents in some of the categories seemed far less likely to be socially beneficial (e.g., drug-related, gang-like, escalating arguments) than in others (e.g., home invasions).

Officer-Involved Shootings and Concealed Carry Weapons Permitting Laws: Analysis of Gun Violence Archive Data, 2014-2020

About 1,000 civilians are killed every year by a law enforcement officer in the USA, more than 90% by firearms. Most civilians who are shot are armed with a firearms. Higher rates of officer-involved shootings (OIS) are positively associated with state-level firearm ownership. Laws relaxing restrictions on civilians carrying concealed firearms (CCW) have been associated with increased violent crime. This study examines associations between CCW laws and OIS. We accessed counts of fatal and nonfatal OIS from the Gun Violence Archive (GVA) from 2014-2020 and calculated rates using population estimates. We conducted legal research to identify passage years of CCW laws. We used an augmented synthetic control models with fixed effects to estimate the effect of Permitless CCW law adoption on OIS over fourteen biannual semesters. We calculated an inverse variance weighted average of the overall effect. On average, Permitless CCW adopting states saw a 12.9% increase in the OIS victimization rate or an additional 4 OIS victimizations per year, compared to what would have happened had law adoption not occurred. Lax laws regulating civilian carrying of concealed firearms were associated with higher incidence of OIS. The increase in concealed gun carrying frequency associated with these laws may influence the perceived threat of danger faced by law enforcement. This could contribute to higher rates of OIS.

Compounding Trauma: the Intersections of Racism, Law Enforcement, and Injury

Purpose of Review

Traumatic injury sits at the nexus of law enforcement and structural racism. This narrative review aims to explore the major impacts of law enforcement on health, its intersections with US structural racism, and their joint impacts on traumatic injury and injury care.

Recent Findings

Many of the same forces of systemic disadvantage that put Black people, other people of color, and other marginalized groups at risk for violent injury also expose these same individuals and communities to intensive policing. Recent evidence speaks to the broad impact of police exposure and police violence on individual and community physical and mental health. Moreover, injured patients who are exposed to law enforcement during their care are at risk for erosion of trust in and relationships with their healthcare providers. To optimize the role of law enforcement agencies in injury prevention, collaboration across sectors and with communities is essential.

Summary

A broad approach to the prevention of injury and violence must incorporate an understanding of the intersecting impacts of law enforcement and structural racism on health and traumatic injury. Clinicians who seek to provide trauma-informed injury care should incorporate an understanding of the role of law enforcement in individual and community health.

Analysis of Firearm Violence During the COVID-19 Pandemic in the US

IMPORTANCE

In the US, the COVID-19 pandemic intensified some conditions that may contribute to firearm violence, and a recent surge in firearm sales during the pandemic has been reported. However, patterns of change in firearm violence in the first year of the COVID-19 pandemic in the US remain unclear.

OBJECTIVE

To quantify the changes in interpersonal firearm violence associated with the pandemic across all 50 US states and the District of Columbia.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study examined 50 US states and the District of Columbia from January 1, 2016, to February 28, 2021. The COVID-19 pandemic period was defined as between March 1, 2020, and February 28, 2021. Statistical analysis was performed from April to December 2021.

MAIN OUTCOMES AND MEASURES

A 2-stage interrupted time-series design was used to examine the excess burden of firearm-related incidents, nonfatal injuries, and deaths associated with the pandemic while accounting for long-term trends and seasonality. In the first stage, separate quasi-Poisson regression models were fit to the daily number of firearm events in each state. In the second stage, estimates were pooled using a multivariate meta-analysis.

RESULTS

In the US (all 50 states and the District of Columbia) during the pandemic period of March 1, 2020, to February 28, 2021, there were 62 485 identified firearm-related incidents, 40 021 firearm-related nonfatal injuries, and 19 818 firearm-related deaths. The pandemic period was associated with 8138 (95% empirical confidence interval [eCI], 2769-12 948) excess incidents (increase of 15.0% [95% eCI, 4.6%-26.1%]), 10 222 (95% eCI, 8284-11 650) excess nonfatal injuries (increase of 34.3% [95% eCI, 26.1%-41.1%]), and 4381 (95% eCI, 2262-6264) excess deaths (increase of 28.4% [95% eCI, 12.9%-46.2%]). The increase in firearm-related violence was more pronounced from June to October 2020 and in Minnesota and New York State.

CONCLUSIONS AND RELEVANCE

In the US, the first year of the COVID-19 pandemic was associated with an excess burden of firearm-related incidents, nonfatal injuries, and deaths, with substantial temporal and spatial variations.

Assessing Data Completeness, Quality, and Representativeness of Justifiable Homicides in the FBI's Supplementary Homicide Reports: A Research Note

Introduction

The most widely used data set for studying police homicides-the Supplementary Homicide Reports (SHR) kept by the Federal Bureau of Investigation-is collected from a voluntary sample.

Materials and Methods

Using a journalist-curated database of police-related deaths, we find the SHR police homicide data to be substantially incomplete. This is due to both non-reporting and substantial under-reporting by agencies. Further, our inquiry discloses a pattern of error in identifying "victims" and "offenders" in the data, and finds that investigating agencies are often incorrectly listed as the responsible agency, which seriously jeopardizes police department-level analyses. Finally, there is evidence of sample bias such that the SHR data system is not representative of all police departments, nor is it representative of large police departments.

Conclusions

We conclude that the SHR data is of dubious value for assessing correlates of police homicides in the United States, as all analyses using it will reflect these widespread biases and significant undercounts. Analysis of SHR data for these purposes should cease.

Factors associated with police shooting mortality: A focus on race and a plea for more comprehensive data

OBJECTIVES

To quantify nonfatal injurious police shootings of people and examine the factors associated with victim mortality.

METHODS

We gathered victim-level data on fatal and nonfatal injurious police shootings from four states that have such information publicly available: Florida (2009-14), Colorado (2010-19), Texas (2015-19), and California (2016-19). For each state, we examined bivariate associations between mortality and race/ethnicity, gender, age, weapon, and access to trauma care. We also estimated logistic regression models predicting victim mortality in each state.

RESULTS

Forty-five percent of these police shooting victims (N = 1,322) did not die. Black-white disparities were more pronounced in nonfatal injurious police shootings than in fatal police shootings. Overall, Black victims were less likely than white victims to die from their wound(s). Younger victims were less likely to die from their wound(s), as well as those who were unarmed.

CONCLUSIONS

Racial and age disparities in police shootings are likely more pronounced than previous estimates suggest.

POLICY IMPLICATIONS

Other states should strongly consider compiling data like that which is currently being gathered in California. Absent data on nonfatal injurious police shootings-which account for a large share of deadly force incidents-researchers and analysts must be cautious about comparing and/or ranking jurisdictions in terms of their police-involved fatality rates.

A most vulnerable population: Black men

Black men disproportionately experience the worst health outcomes among U.S. populations. Systemic social, political, and healthcare problems are important intersecting issues of Black men's poor health outcomes. As nursing is one of the most trusted professions, it is nurses' responsibilities to include care for vulnerable populations. In this creative controversy an alternative perspective of Black men as a vulnerable population is proposed. Potential tensions and an introspective call to action for all nurses is included.

Firearm injuries during legal interventions Nationwide analysis

INTRODUCTION

There is limited literature on firearm injuries during legal interventions. The purpose of this study was to examine the epidemiology, injury characteristics, and outcomes of both civilians and law enforcement officials (LEOs) who sustained firearm injuries over the course of legal action.

METHODS

Retrospective observational study using data from the National Trauma Data Bank (2015-2017) was performed. All patients who were injured by firearms during legal interventions were identified using the International Classification of Disease, Tenth Revision, external cause of injury codes. The study groups were injured civilian suspects and police officers. Demographics, injury characteristics, and outcomes were analyzed and compared between the groups. Primary outcomes were the clinical and injury characteristics among the victims.

RESULTS

A total of 1,411 patients were included in the study, of which 1,091 (77.3%) were civilians, 289 officers (20.5%), and 31 bystanders (2.2%). Overall, 95.2% of patients were male. Compared with LEOs, civilians were younger (31 vs. 34 years, p = 0.007) and more severely injured (median Injury Severity Score, 13 vs. 10 [p = 0.005]; Injury Severity Score >15, 44.4% vs. 37.1% [p = 0.025]). Civilians were more likely to sustain severe (Abbreviated Injury Scale, ≥3) intra-abdominal injuries (26.8% vs. 16.1%, p < 0.001) and spinal fractures (13.0% vs. 6.9%, p = 0.004). In-hospital mortality and overall complication rate were similar between the groups (mortality: civilians, 24.7% vs. LEOs, 27.3% [p = 0.360]; overall complications: civilians, 10.3% vs. LEOs, 8.4% [p = 0.338]).

CONCLUSION

Firearm injuries during legal interventions are associated with significant injury burden and a higher mortality than the reported mortality in gunshot wounds among civilians. The mortality and overall complication rate were similar between civilian suspects and law enforcement officials.

LEVEL OF EVIDENCE

Epidemiologic, level IV.

Firearm purchasing and firearm violence during the coronavirus pandemic in the United States: a cross-sectional study

BACKGROUND

Firearm violence is a significant public health problem in the United States. A surge in firearm purchasing following the onset of the coronavirus pandemic may have contributed to an increase in firearm violence. We sought to estimate the state-level association between firearm purchasing and interpersonal firearm violence during the pandemic.

METHODS

Cross-sectional study of the 48 contiguous states and the District of Columbia from January 2018 through July 2020. Data were obtained from the National Instant Criminal Background Check System (a proxy for firearm purchasing) and the Gun Violence Archive. Using negative binomial regression models, we estimated the association between cumulative excess firearm purchases in March through July 2020 (measured as the difference between observed rates and those expected from autoregressive integrated moving average models) and injuries (including nonfatal and fatal) from intentional, interpersonal firearm violence (non-domestic and domestic violence).

RESULTS

We estimated that there were 4.3 million excess firearm purchases nationally from March through July 2020 and a total of 4075 more firearm injuries than expected from April through July. We found no relationship between state-level excess purchasing and non-domestic firearm violence, e.g., each excess purchase per 100 population was associated with a rate ratio (RR) of firearm injury from non-domestic violence of 0.76 (95% CI: 0.50-1.02) in April; 0.99 (95% CI: 0.72-1.25) in May; 1.10 (95% CI: 0.93-1.32) in June; and 0.98 (95% CI: 0.85-1.12) in July. Excess firearm purchasing within states was associated with an increase in firearm injuries from domestic violence in April (RR: 2.60; 95% CI: 1.32-5.93) and May (RR: 1.79; 95% CI: 1.19-2.91), though estimates were sensitive to model specification.

CONCLUSIONS

Nationwide, firearm purchasing and firearm violence increased substantially during the first months of the coronavirus pandemic. At the state level, the magnitude of the increase in purchasing was not associated with the magnitude of the increase in firearm violence. Increases in purchasing may have contributed to additional firearm injuries from domestic violence in April and May. Results suggest much of the rise in firearm violence during our study period was attributable to other factors, indicating a need for additional research.

Aggression, Escalation, and Other Latent Themes in Legal Intervention Deaths of Non-Hispanic Black and White Men: Results From the 2003‒2017 National Violent Death Reporting System

Objectives. To investigate racial/ethnic differences in legal intervention‒related deaths using state-of-the-art topic modeling of law enforcement and coroner text summaries drawn from the 2003-2017 US National Violent Death Reporting System (NVDRS). Methods. Employing advanced topic modeling, we identified 8 topics consistent with dangerousness in death incidents in the NVDRS death narratives written by public health workers (PHWs). Using logistic regression, we then evaluated racial/ethnic differences in PHW-coded variables and narrative topics among 4981 males killed by legal intervention, while adjusting for age, county-level characteristics, and year. Results. Black, as compared with White, decedents were younger and their deaths were less likely to include PHW-coded mental health or substance use histories, weapon use, or positive toxicology for alcohol or psychoactive drugs, but more likely to include "gangs-as-an-incident-precipitant" coding. Topic modeling revealed less frequent thematic representation of "physical aggression" or "escalation" but more of "gangs or criminal networks" among Black versus White decedents. Conclusions. While Black males were more likely to be victims of legal intervention deaths, PHW-coded variables in the NVDRS and death narratives suggest lower threat profiles among Black versus similar White decedents. The source of this greater risk remains undetermined.

US law enforcement policy predictors of race-specific police fatalities during 2015-16

Mounting evidence suggests that law enforcement organizational factors contribute to higher incidence and racial disparities in police killings. To determine whether agency policies contribute to race-specific civilian fatalities, this exploratory study compared fatality rates among agencies with and without selected policies expected to reduce killings. A cross-section of 1085 fatalities in the 2015-2016 The Counted public-use database were matched to 481 agencies in the 2013 Law Enforcement Management and Administrative Statistics (LEMAS) database. Negative binomial regression estimated incidence rate ratios (IRR) adjusted for agency type, number of officers, percent female personnel, median income, percent with a bachelor's degree, violent crime rate, and population size, with inference using robust standard errors. Agencies with greater proportions of full-time personnel (range 43-100%) had lower rates of all (IRR = 0.85; 95% confidence interval [CI] = 0.77-0.93) and non-White civilian killings (IRR = 0.85; CI = 0.73-0.99). Mission statements predicted lower rates of all (IRR = 0.70; CI = 0.58-0.84) and White killings (IRR = 0.60; CI = 0.40-0.90). Community evaluation and more types of personnel incentives predicted lower rates of White (IRR = 0.82; CI = 0.68-0.99) and non-White killings (IRR = 0.94; CI = 0.89-1.00), respectively. Increasing video use predicted higher rates of White killings (IRR = 1.13; CI = 1.01-1.28). No policies were significantly associated with Black civilian killings. Law enforcement policies that help reduce police killings may vary across racial groups with the least benefit for Black civilians. Impact evaluations and meta-analyses of initiatives aimed to mitigate fatalities should be explored, particularly policies to address anti-Black bias. A national registry tracking all police killings and agency policies is urgently needed to inform law enforcement policies aimed to mitigate civilian fatalities.

Making the news: Victim characteristics associated with media reporting on firearm injury

Firearm injury is a public health crisis in the United States. Selective media coverage may contribute to incomplete public understanding of firearm injury. To better understand how firearm injury is communicated to the public, we analyzed media coverage of intentional, interpersonal shootings in 3 U.S. cities. We hypothesized that multiple shootings and fatal shootings would be more likely to make the news, as would shootings affecting children, women, and white individuals. We compared police department data on shootings to media reports drawn from the Gun Violence Archive (GVA) for 2017 in Philadelphia, PA, Rochester, NY, and Cincinnati, OH. GVA reports were matched to police data by shooting date, location, victim age, and gender. Matched victims were compared to unmatched using chi2 tests for categorical variables and Kruskal Wallis tests for continuous variables. Philadelphia police reported 1216 firearm assault victims; Cincinnati police reported 407; and Rochester police reported 178. News reports covered 562 (46.2%), 222 (54.6%), and 116 (65.2%) victims, respectively. Fatal shootings were more often reported as were shootings involving multiple victims or women. Half of shooting victims did not make the news. Selective reporting likely limits awareness of the public health impact of firearm injury. Researchers and policy makers should work with journalists and editors to improve the quantity and content of reporting on firearm injury.

Selection bias and misclassification in case-control studies conducted using the National Violent Death Reporting System

Conducting case-control studies using the National Violent Death Reporting System (NVDRS) has the potential to introduce selection bias and misclassification through control selection. Some studies that use NVDRS compare groups of individuals who died by one mechanism, intent or circumstance, to individuals who died by another mechanism, intent or circumstance. For aetiological studies within NVDRS, the use of controls who had a different type of violent death has the potential to introduce selection bias, while relying on narrative summaries for exposure measurement may result in misclassification. We discuss these two methodological issues, and identify an unusual circumstance in which selection of live controls within NVDRS can be employed.

A Typology of Civilians Shot and Killed by US Police: a Latent Class Analysis of Firearm Legal Intervention Homicide in the 2014-2015 National Violent Death Reporting System

Approximately 1000 people are killed by police acting in the line of duty each year. Historically, research on these deaths, known as legal intervention homicides (LIH), has been limited by data that is either contextually rich but narrow in scope and not readily available to the public (e.g., police department reports from a single city), or detail-poor but geographically broad, large, and readily available (and maintained by federal agencies) (e.g., vital statistics and supplemental homicide reports). Over the past 5 years, however, researchers have turned to the National Violent Death Reporting System (NVDRS), which captures nearly all lethal police shootings in participating states while providing detailed incident and victim information. The current study extends prior work on police-involved lethal shootings in three important ways. First, we use latent class analysis to construct a data-driven, exhaustive, mutually exclusive typology of these events, using NVDRS data 2014-2015. Second, rather than fitting some, but not all cases into predefined sub-types, every case is assigned membership to a particular emergent class. Third, we use a validated case identification process in NVDRS to identify incidents of lethal police-involved shootings. Seven classes emerge. Classes differ across important incident and victim characteristics such as the event that brought the victim and law enforcement together, the highest level of force used by the victim against law enforcement, and the kind of weapon, if any, used by the victim during the incident. Demographic variables do not distribute uniformly across classes (e.g., the latent class in which the victim appeared to pose minimal threat to law enforcement was the only class in which the plurality of victims was a non-white race). Our approach to generating these typologies illustrates how data-driven techniques can complement subjective classification schemes and lay the groundwork for analogous analyses using police encounter data that include fatal and non-fatal outcomes.

Fatal police shootings of civilians, by rurality

In the United States, firearm homicides disproportionately occur in urban areas. We examine whether the same is true for fatal police shootings. We use data on fatal police shootings from Washington Post's "Fatal Force Database" (2015-2017). Using Census population estimates, we examine rates of fatal police shootings, stratified by race/ethnicity (White, Black, Hispanic), across urban and rural areas using five different classification schemes. Two classification schemes-from the National Center for Health Statistics and the US Department of Agriculture-use counties as the basic unit. Three classification schemes-from the National Center for Education Statistics, the US Census Bureau, and the website "FiveThirtyEight" use zip codes. There were just under 1000 fatal police shootings per year from 2015 to 2017, a rate of 0.31 per 100,000 population. Black victimization rates were more than twice those for Whites, with Hispanic victimization rates in between. Across all classification schemes there was little difference in rates of fatal police shootings between urban and rural areas, with suburbs having somewhat lower rates. Among Whites, rates of fatal police shooting victimization were higher in rural areas compared to urban areas, while among Blacks the rates were higher in more urban areas. Our results suggest that efforts to reduce police shootings of civilians should include rural and suburban as well as urban areas.