Nathalie Huguet, Ph.D.
Center for Public Health Studies
Portland State University
AFSP 2009 Young Investigator Grant
"Epidemiology of Undetermined Deaths:Prevalence and Patterns of Misclassified Suicides"
Research Connection :: March 2014
National Violent Death Registry System (NVDRS)—A Tool Worth Sponsorship
On February 27th, 2014 hundreds of AFSP advocates asked all 535 members of Congress to fully fund the National Violent Death Registry Surveillance (NVDRS). Without the NVDRS there is little information gathered about people who die by suicide beyond the death certificate. For example, death certificates do not distinguish people who are veterans from those who are on active duty at the time of death. This is important because the rate of suicide among veterans has been reported to be higher than the rate in the general population. The NVDRS also provides the opportunity for a detailed look at determination of cause of death, which is critical for understanding suicide.
Where the NVDRS is fully implemented, information is gathered from coroner or medical examiner records, police reports, death certificates, toxicology labs, crime labs, and Alcohol, Tobacco, Firearms, and Explosives gun trace reports. Information that is part of the NVDRS includes greater detail regarding the social, medical and psychological state of the individual at the time of their death from available sources including family members, friends and witnesses.
Currently the NVDRS is only active in 18 states even though the cost for funding this vital data base that could provide essential information about suicide is only $25 million.
Dr. Huguet used the NVDRS, the Department of Defense Casualty Analysis Survey (DCAS), the American Community Survey (ACS) and the Department of Veteran Affairs (VA) veteran population estimates from 2003-2010. She compared these data bases to test whether the NVDRS provides accurate information regarding military status (active or veteran) and to test whether veterans actually do have a higher rate of suicide than the general population. In another paper she examined the use of the term “undetermined death” as a possible mechanism leading to misclassification of suicide based on race (White vs. African American) and varying by state.
Overall the NVDRS was shown to provide a reliable estimate of the number of veteran suicides. The higher rate of suicides for veterans relative to the general population during this time period was also confirmed.
Given the breadth of data available from the NVDRS, the demographic characteristics of people considered to have an “undetermined” cause of death were shown to vary by race and by state. In addition to being twice as likely to be classified as "undetermined," African Americans were more likely to have missing information. In many states poisoning is automatically classified as “undetermined” (likely leading to underestimation of suicide rates by overdose in those states) and this study found that the specific type of poisoning varied by race.
This research demonstrates the importance of the additional information gathered by the NVDRS above and beyond death certificates. The NVDRS allows for a more in-depth study of suicide when compared with death certificates because it provides a wealth of information about the person who died by suicide.