Trends in Care and Treatment for Persons Aged ≥13 Years with HIV Infection 17 U.S. Jurisdictions, 2012-2015.

BACKGROUND: Care and viral suppression national goals for HIV infection are not being met for many at-risk groups. Assessment of the trends in national outcomes for linkage to care, receipt of care, and viral suppression among these groups is necessary to reduce transmission. METHODS: Data reported to the National HIV Surveillance System by December 2016 were used to identify cases of HIV infection among persons aged 13 years and older in one of 17 identified jurisdictions with complete laboratory reporting. We estimated national trends in HIV-related linkage to care, receipt of care and viral suppression using estimated annual percent change from 2012-2015 for various characteristics of interest, overall and stratified by sex and race/ethnicity. RESULTS: Overall, trends in linkage to and receipt of care and viral suppression increased from 2012-2015. Generally, linkage to and receipt of care increased among young black and Hispanic/Latino males, those with infection attributed to male-to-male sexual contact, and those not in stage 3 [AIDS] at HIV diagnosis. All sub-groups showed improvement in viral suppression. Within years, there remains a substantial disparity in receipt of care and viral suppression among racial/ethnic groups. CONCLUSION: While trends are encouraging, scientifically proven prevention programs targeted to high-risk populations are the foundation for stopping transmission of HIV infection. Frequent testing to support early diagnosis and prompt linkage to medical care, particularly among young men who have male to male sexual contact, black and Hispanic/Latino populations, are key to reducing transmission at all stages of disease.

HIV Infection Care and Viral Suppression Among People Who Inject Drugs, 28 U.S. Jurisdictions, 2012-2013.

OBJECTIVES: Assess outcomes along the care continuum for HIV-infected people who inject drugs (PWID), by type of facility and stage of infection at diagnosis. METHODS: Data reported by 28 jurisdictions to the National HIV Surveillance System by December 2014 were used to identify PWID aged ≥13 years, diagnosed with HIV infection before December 31, 2013. Analyses used the CDC definition of linkage to care (LTC), retention in care (RIC), and viral suppression (VS), and are stratified by age, sex, race/ethnicity, and type of facility and stage of HIV infection at diagnosis. RESULTS: Of 1,409 PWID diagnosed with HIV in 2013, 1,116 (79.2%) were LTC with the lowest percentages among males (78.4%); blacks (77.5%) ages 13-24 years (69.0%); those diagnosed in early stage infection (71.6%); and at screening, diagnostic, or referral agencies (60.0%). Of 80,958 PWID living with HIV in 2012, 40,234 (49.7%) were RIC and 34,665 (42.8%) achieved VS. The lowest percentages for RIC and VS were among males (47.1% and 41.3% respectively); those diagnosed with late stage disease (47.1% and 42.4%); and young people. Whites had the lowest RIC (47.0%) while blacks had the lowest VS (41.1%). CONCLUSION: Enhanced LTC activities are needed for PWID diagnosed at screening, diagnostic or referral agencies versus those diagnosed at inpatient or outpatient settings, especially among young people and blacks diagnosed in early stage infection. Less than half of PWID are retained in care or reach viral suppression indicating the need for continued engagement and return to care activities over the long term.

Comparative mortality among people diagnosed with HIV infection or AIDS in the U.S., 2001-2010.

OBJECTIVE: The comparative mortality figure (CMF) is the expected number of deaths in the standard population compared with those observed. We assessed state-based CMFs for people with HIV infection to allow standardized assessment of mortality in all states. METHODS: We used National HIV Surveillance System data to compute CMFs for people diagnosed with HIV and AIDS from 2001 to 2010 who met the CDC HIV case definition; were alive on December 31, 2009; and died during 2010. RESULTS: In 33 U.S. states with name-based HIV reporting since 2001, the 2010 CMF for people with an HIV diagnosis was 2.8 compared with 4.5 for those with an AIDS diagnosis. CMFs for males were higher than for females (3.4 vs. 3.1) and black people had higher CMFs than white people for HIV (3.2 vs. 2.2) and AIDS (4.7 vs. 4.3). CMFs by state ranged from 0.9 to 4.2 for HIV and 1.9 to 9.7 for AIDS. In 50 states and the District of Columbia with AIDS reporting, CMFs for males and females were similar (4.5 and 4.6, respectively), CMFs for black people remained higher than for white people (5.0 and 3.9, respectively), and the range for states remained broad (1.2-9.4). CONCLUSION: State mortality figures varied based on population composition and disease stage at diagnosis, possibly indicating a need for state-specific testing, linkage to care, and viral suppression strategies to reduce mortality.

Characteristics of U.S. suicide decedents in 2005-2010 who had received mental health treatment.

OBJECTIVE: To inform suicide prevention efforts in mental health treatment, the study assessed associations between recent mental health treatment, personal characteristics, and circumstances of suicide among suicide decedents. METHODS: Data from 18 states reporting to the National Violent Death Reporting System between 2005 and 2010 (N=57,877 suicides) were used to compare circumstances among adult decedents receiving any or no type of mental health treatment within two months before death. RESULTS: Of suicide decedents, 28.5% received treatment before suicide. Several variables were associated with higher odds of receiving treatment, including death by poisoning with commonly prescribed substances (adjusted odds ratio [AOR]=3.04, 95% confidence interval [CI]=2.84-3.26), a history of suicide attempts (AOR=2.77, CI=2.64-2.90), depressed mood (AOR=1.69, CI=1.62-1.76), and nonalcoholic substance abuse or dependence (AOR=1.13, CI=1.07-1.19). CONCLUSIONS: For nearly a third of all suicide decedents, better mental health care might have prevented death. Efforts to reduce access to lethal doses of prescription medications seem warranted to prevent overdosing with commonly prescribed substances.

Evaluation of the National Human Immunodeficiency Virus Surveillance System for the 2011 diagnosis year.

CONTEXT: In 2009, the Centers for Disease Control and Prevention completed migration of all 59 surveillance project areas (PAs) from the case-based HIV/AIDS Reporting System to the document-based Enhanced HIV/AIDS Reporting System. OBJECTIVES: We conducted a PA-level assessment of Enhanced HIV/AIDS Reporting System process and outcome standards for HIV infection cases. DESIGN: Process standards were reported by PAs and outcome standards were calculated using standardized Centers for Disease Control and Prevention SAS code. SETTING: A total of 59 PAs including 50 US states, the District of Columbia, 6 separately funded cities (Chicago, Houston, Los Angeles County, New York City, Philadelphia, and San Francisco), and 2 territories (Puerto Rico and the Virgin Islands). PARTICIPANTS: Cases diagnosed or reported to the PA surveillance system between January 1, 2011, and December 31, 2011, using data collected through December 2012. MAIN OUTCOME MEASURES: Process standards for death ascertainment and intra- and interstate case de-duplication; outcome standards for completeness and timeliness of case reporting, data quality, intrastate duplication rate, risk factor ascertainment, and completeness of initial CD4 and viral load reporting. RESULTS: Fifty-five of 59 PAs (93%) reported linking cases to state vital records death certificates during 2012, 76% to the Social Security Death Master File, and 59% to the National Death Index. Seventy percent completed monthly intrastate, and 63% completed semiannual interstate de-duplication. Eighty-three percent met the 85% or more case ascertainment standard, and 92% met the 66% or more timeliness standard; 75% met the 97% or more data quality standard; all PAs met the 5% or less intrastate duplication rate; 41% met the 85% or more risk factor ascertainment standard; 90% met the 50% or more standard for initial CD4; and 93% met the same standard for viral load reporting. Overall, 7% of PAs met all 11 process and outcome standards. CONCLUSIONS: Findings support the need for continued improvement in HIV surveillance activities and monitoring of system outcomes.

Precipitating circumstances of suicide among youth aged 10-17 years by sex: data from the National Violent Death Reporting System, 16 states, 2005-2008.

We examined the circumstances that precipitated suicide among 1,046 youth aged 10-17 years in 16 U.S. states from 2005 to 2008. The majority of deaths were among male subjects (75.2%), non-Hispanic whites (69.3%), those aged 16-17 years (58.1%), those who died by hanging/strangulation/suffocation (50.2%) and those who died in a house or an apartment (82.5%). Relationship problems, recent crises, mental health problems, and intimate partner and school problems were the most common precipitating factors and many differed by sex. School problems were reported for 25% of decedents, of which 30.3% were a drop in grades and 12.4% were bullying related. Prevention strategies directed toward relationship-building, problem-solving, and increasing access to treatment may be beneficial for this population.

Surveillance for violent deaths--National Violent Death Reporting System, 16 states, 2009.

PROBLEM/CONDITION: An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2009. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. REPORTING PERIOD COVERED: 2009. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS data collection began in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two (Ohio and Michigan) in 2010, for a total of 19 states. This report includes data from 16 states that collected statewide data in 2009. California is excluded because data were collected in only four counties. Ohio and Michigan are excluded because data collection did not begin until 2010. RESULTS: For 2009, a total of 15,981 fatal incidents involving 16,418 deaths were captured by NVDRS in the 16 states included in this report. The majority (60.6%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (24.7%), deaths of undetermined intent (14.2%), and unintentional firearm deaths (0.5%). Suicides occurred at higher rates among males, non-Hispanic whites, American Indians/Alaska Natives, and persons aged 45-54 years. Suicides occurred most often in a house or apartment and involved the use of firearms. Suicides were preceded primarily by mental health, intimate partner, or physical health problems or by a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and persons aged 20-24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were preceded primarily by arguments and interpersonal conflicts or in conjunction with another crime. Characteristics associated with other manners of death, circumstances preceding death, and special populations also are highlighted in this report. INTERPRETATION: This report provides a detailed summary of data from NVDRS for 2009. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain racial/ethnic minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental health problems, and recent crises were among the primary factors that might have precipitated the fatal injuries. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. PUBLIC HEALTH ACTION: For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Additional efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Surveillance for violent deaths--National Violent Death Reporting System, 16 states, 2008.

PROBLEM/CONDITION: An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2008. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. REPORTING PERIOD COVERED: 2008. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS data collection began in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two in 2010 (Ohio and Michigan) for a total of 19 states. This report includes data from 16 states that collected statewide data in 2008; data from California are not included in this report because NVDRS was implemented only in a limited number of California cities and counties rather than statewide. Ohio and Michigan are excluded because they did not begin data collection until 2010. RESULTS: For 2008, a total of 15,755 fatal incidents involving 16,138 deaths were captured by NVDRS in the 16 states included in this report. The majority (58.7%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e. deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (26.4%), deaths of undetermined intent (14.5%), and unintentional firearm deaths (0.4%). Suicides occurred at higher rates among males, American Indians/Alaska Natives (AI/ANs), non-Hispanic whites, and persons aged 45-54 years. Suicides occurred most often in a house or apartment (70.6%) and involved the use of firearms (51.5%). Suicides were precipitated primarily by mental health (45.4%), intimate partner (30.9%), or physical health problems (22.6%), or by a crisis during the preceding 2 weeks (27.9%). Homicides occurred at higher rates among males and persons aged 20-24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm (65.8%) and occurred in a house or apartment (52.5%) or on a street/highway (21.3%). Homicides were precipitated primarily by arguments (41.4%) and interpersonal conflicts (18.4%) or in conjunction with another crime (30.2%). Other manners of death and special situations or populations also are highlighted in this report. INTERPRETATION: This report provides a detailed summary of data from NVDRS for 2008. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental health problems, and recent crises were among the primary precipitating factors. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. PUBLIC HEALTH ACTION: For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Surveillance for violent deaths--National Violent Death Reporting System, 16 States, 2007.

PROBLEM/CONDITION: An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 states for 2007. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. REPORTING PERIOD COVERED: 2007. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS began operation in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two states (Ohio and Michigan) were funded to begin data collection in 2010, totaling 19 states. This report includes data from 16 states that collected statewide data in 2007. California data are not included in this report because NVDRS data are collected only in a limited number of California cities and counties rather than statewide. Ohio and Michigan are excluded because they did not begin data collection until 2010. RESULTS: For 2007, a total of 15,882 fatal incidents involving 16,319 deaths occurred in the 16 NVDRS states included in this report. The majority (56.6%) of deaths was suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (28.0%), deaths of undetermined intent (14.7%), and unintentional firearm deaths (0.7%). Suicides occurred at higher rates among males, American Indians/Alaska Natives, non-Hispanic whites, and persons aged 45--54 years. Suicides occurred most often in a house or apartment and involved the use of firearms. Suicides were precipitated primarily by mental-health, intimate-partner, or physical-health problems, or by a crisis during the preceding 2 weeks. Homicides occurred at higher rates among males and persons aged 20--24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were precipitated primarily by arguments and interpersonal conflicts or in conjunction with another crime. Other manners of death and special situations or populations also are highlighted in this report. INTERPRETATION: This report provides a detailed summary of data from NVDRS for 2007. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence disproportionately affected adults aged <55 years, males, and certain minority populations. For homicides and suicides, relationship problems, interpersonal conflicts, mental-health problems, and recent crises were among the primary precipitating factors. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. PUBLIC HEALTH ACTION: For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Surveillance for violent deaths--national violent death reporting system, 16 States, 2006.

PROBLEM/CONDITION: An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2006. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. REPORTING PERIOD COVERED: 2006. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS began operation in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004 and four (California, Kentucky, New Mexico, and Utah) in 2005, for a total of 17 states. This report includes data from 16 states that collected statewide data; data from California are not included in this report because NVDRS has been implemented only in a limited number of California cities and counties rather than statewide. RESULTS: For 2006, a total of 15,007 fatal incidents involving 15,395 violent deaths occurred in the 16 NVDRS states included in this report. The majority (55.9%) of deaths were suicides, followed by homicides and deaths involving legal intervention (e.g. a suspect is killed by a law enforcement officer in the line of duty)(28.2%), violent deaths of undetermined intent (15.1%), and unintentional firearm deaths (0.7%). Suicides occurred at higher rates among males, American Indians/Alaska Natives (AI/ANs), non-Hispanic whites, and persons aged 45--54 years and occurred most often in a house or apartment and involved the use of firearms. Suicides were precipitated primarily by mental-health, intimate-partner, or physical-health problems or by a crisis during the preceding 2 weeks. Homicides occurred at higher rates among males and persons aged 20--24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were precipitated primarily by arguments and interpersonal conflicts or in conjunction with another crime. Other manners of death and special situations or populations also are highlighted in this report. INTERPRETATION: This report provides a detailed summary of data concerning violent deaths collected by NVDRS for 2006. The results indicate that violent deaths resulting from self-inflicted or interpersonal violence affected adults aged 20--54 years, males, and certain minority populations disproportionately. For many types of violent death, relationship problems, interpersonal conflicts, mental-health problems, and recent crises were among the primary precipitating factors. Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. PUBLIC HEALTH ACTION: For the occurrence of violent deaths in the United States to be better understood and ultimately prevented, accurate, timely, and comprehensive surveillance data are necessary. NVDRS data can be used to track the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states participating in NVDRS, with an ultimate goal of full national representation.

Characteristics of perpetrators in homicide-followed-by-suicide incidents: National Violent Death Reporting System--17 US States, 2003-2005.

Homicide-followed-by-suicide (referred to as "homicide-suicide") incidents are rare events but can have a profound impact on families and communities. A better understanding of perpetrator characteristics and how they compare with those of other homicide suspects and suicide decedents might provide insight into the nature of these violent acts. This report is based on 2003-2005 data from 17 US states participating in the National Violent Death Reporting System, a unique, incident-based, active surveillance system that integrates data on violent deaths from multiple sources. Of the 408 homicide-suicide incidents identified, most incidents were committed with a firearm (88.2%) and perpetrated by males (91.4%), those over 19 years of age (97.6%), and those of white race (77.0%); however, just over half of filicide (killing of children)-suicides (51.5%) were perpetrated by females. Over 55% of male homicide-suicide perpetrators versus 26.4% of other male suicide decedents had prior intimate partner conflicts (P < 0.001). In fact, having a history of intimate partner conflicts was even common among homicide-suicide perpetrators who did not victimize their intimate partners. Recognition of the link between intimate partner conflicts and homicide-suicide incidents and strategies involving collaboration among the court/legal and mental health systems might prevent these incidents.

Surveillance for violent deaths--National Violent Death Reporting System, 16 states, 2005.

PROBLEM/CONDITION: An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 U.S. states for 2005. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. REPORTING PERIOD COVERED: 2005. DESCRIPTION OF SYSTEM: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS began operation in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004 and four (California, Kentucky, New Mexico, and Utah) in 2005, for a total of 17 states. This report includes data from 16 states; data from California are not included in this report because NVDRS has been implemented only in a limited number of California cities and counties rather than statewide as in other states. RESULTS: For 2005, a total of 15,495 fatal incidents involving 15,962 violent deaths occurred in the 16 NVDRS states included in this report. The majority (56.1%) of deaths were suicides, followed by homicides and deaths involving legal interventions (29.6%), violent deaths of undetermined intent (13.3%), and unintentional firearm deaths (0.7%). Fatal injury rates varied by sex, race/ethnicity, age group, and method of injury. Rates were substantially higher for males than for females and for American Indians/Alaska Natives (AI/ANs) and blacks than for whites and Hispanics. Rates were highest for persons aged 20-24 years. For method of injury, the three highest rates were reported for firearms, poisonings, and hanging/strangulation/suffocation. Suicides occurred at higher rates among males, AI/ANs, whites, and older persons and most often involved the use of firearms in the home. Suicides were precipitated primarily by mental illness, intimate partner or physical health problems, or a crisis during the previous 2 weeks. Homicides occurred at higher rates among males and young adult blacks and most often involved the use of firearms in the home or on a street/highway. Homicides were precipitated primarily by an argument over something other than money or property or in conjunction with another crime. Similar variation was reported among the other manners of death and special situations or populations highlighted in this report. INTERPRETATION: This report provides the first detailed summary of data concerning violent deaths collected by NVDRS. The results indicate that deaths resulting from self-inflicted or interpersonal violence occur to a varying extent among males and females of every age group and racial/ethnic population. Key factors affecting rates of violent fatal injuries include sex, age group, method of injury, location of injury, and precipitating circumstances (e.g., mental health and substance abuse). Because additional information might be reported subsequently as participating states update their findings, the data provided in this report are preliminary. PUBLIC HEALTH ACTION: Accurate, timely, and comprehensive surveillance data are necessary for the occurrence of violent deaths in the United States to be understood better and ultimately prevented. NVDRS data can be used to track the occurrence of violence-related fatal injuries and assist public health authorities in the development, implementation, and evaluation of programs and policies to reduce and prevent violent deaths and injuries at the national, state, and local levels. The continued development and expansion of NVDRS is essential to CDC's efforts to reduce the personal, familial, and societal costs of violence. Further efforts are needed to increase the number of states using NVDRS, with an ultimate goal of full national representation.