Surveillance for Violent Deaths - National Violent Death Reporting System, 50 States, the District of Columbia, and Puerto Rico, 2023.

Abstract

Problem/condition: In 2023, approximately 23,000 persons died of homicide and 49,000 persons died of suicide in the United States, according to the National Vital Statistics System. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths and suicides that occurred in the 50 states, the District of Columbia, and Puerto Rico in 2023.

Period covered: 2023.

Description of system: NVDRS collects data from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected from all 50 states, the District of Columbia, and Puerto Rico. Forty-seven states had statewide data, three additional states had data from counties representing a subset of their population (31 California counties, representing 74.1% of its population; 38 Florida counties, representing 59.3% of its population; and 13 Texas counties, representing 62.9% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident.

Results: For 2023, NVDRS collected information on 70,133 fatal incidents involving 72,093 deaths. The deaths recorded in NVDRS accounted for 91.6% of all homicides, legal intervention deaths, suicides, unintentional firearm injury deaths, and deaths of undetermined intent in the United States in 2023. In addition, information was collected for 671 fatal incidents involving 730 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately.Of the 72,093 deaths that occurred in the 50 states and the District of Columbia, the majority (62.4%) were suicides, followed by homicides (28.5%), deaths of undetermined intent that might be due to violence (6.9%), legal intervention deaths (1.5%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm injury deaths (<1.0%). Of the 730 deaths reported for Puerto Rico, 66.4% were homicides and 32.9% were suicides.Demographic patterns and circumstances varied by manner of death. In the 50 states and the District of Columbia, the suicide rate was higher for males than for females (23.5 versus 6.1 per 100,000 population). The suicide rate for males was highest for those aged ≥85 years (53.0), whereas for females, the suicide rate was highest for those aged 45-54 years (8.8). In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups (22.7). Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide decedents for whom circumstances were known, suicide was most often preceded by an intimate partner, mental health, or physical health problem or by a recent or impending crisis.The homicide rate was also higher for males (10.8 per 100,000 population) than for females (2.7). Among all homicide victims, the homicide rate was highest among adults aged 20-24 years (14.1) compared with other age groups. Non-Hispanic Black or African American (Black) males experienced the highest homicide rate of any racial or ethnic group (50.6). Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. When circumstances were known, homicide was most often precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male (95.6%) and the legal intervention death rate was highest among men aged 30-34 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in most legal intervention deaths. When circumstances were known, the most frequently reported circumstances for legal intervention deaths were the victim's reported use of a weapon, the victim being previously known to authorities, or that the victim reportedly had mental health or substance use problems.Other manners of death included unintentional firearm injury deaths and deaths of undetermined intent. Unintentional firearm injury deaths occurred most frequently among males, non-Hispanic White (White) persons, and persons aged 15-19 years. When circumstances were known, these deaths most frequently occurred while the shooter was playing with a firearm and most often were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 35-44 years. Poisoning was the most common method of injury in deaths of undetermined intent, often involving opioids (67% positive among decedents tested).In Puerto Rico, the homicide rate was twice as high as the suicide rate and was 10.7 times higher for males than for females. Firearms were the most common method of injury in homicides. When the relationship between the homicide victim and suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Among male homicide victims in Puerto Rico when circumstances were known, the most common precipitating circumstances were drug involvement and the victim previously being known to authorities, whereas among female victims, the most common homicide circumstance was intimate partner violence. The suicide rate in Puerto Rico was also higher for males than for females. The most common suicide method was hanging, strangulation, or suffocation. Depressed mood or currently diagnosed mental health problem were frequent circumstances reported for both male and female suicide decedents.

Interpretation: This report summarizes NVDRS data on violent deaths and suicides that occurred in 2023. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Intimate partner violence precipitated a large proportion of homicides of females. Mental health and substance use problems, previous awareness of the victim by authorities, intimate partner problems, interpersonal conflicts, and acute life stressors were the primary precipitating circumstances for multiple types of deaths examined.

Public health action: The injury-related deaths described in this report are preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of these fatal injuries and assist public health agencies in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent deaths. Violent death reporting system data are helping states identify disproportionately affected groups and implement targeted prevention strategies, including youth suicide-focused analyses in Maryland and veteran suicide-focused initiatives in Michigan and Connecticut that guided statewide partnerships, crisis line outreach, and mental health service expansion.