Analysis of female strangulation homicides in King County, Washington, from 1978 to 2022.

Asphyxia due to strangulation is an uncommon but important modality of homicide that tends to disproportionately involve female victims. The present study was designed to investigate the circumstances, motivations, and injuries associated with strangulation homicides of females and to measure trends in incidence over time. Electronic records of the King County Medical Examiner's Office in Seattle, Washington, were used to compile a data set of all homicides in King County from 1995 through 2022. A second data set of female homicides due to strangulation was constructed with additional records prior to 1995, supplemented with data abstracted from autopsy reports, and linked to the Washington Attorney General's Office Homicide Investigation Tracking System database. This comprehensive data set was used to analyze demographics, circumstances, motives, and injuries of female strangulation homicides from 1978 through 2016. The results found that, from 1995 through 2022, females accounted for 22.8% of 2394 homicides but 80.3% of strangulation homicides. The average annual rate of all strangulation homicides decreased until 2020. Mean ages of female decedents were 27.7 years in homicides associated with sexual assault, 36.8 years with domestic violence, and 63.9 years with robbery. Lethal assaults most often occurred in private homes, and perpetrators were usually well known to the victim. Injuries included petechiae in 83%; ligature marks in 20%; fingernail marks in 1.4%; hyoid fractures in 23%; and thyroid cartilage fractures in 31%. Fractures were more common in manual strangulation and in decedents of ages over 40 years.

Medical Examiner Surveillance of the COVID-19 Pandemic in King County, Washington, USA.

ABSTRACT: The King County Medical Examiner's Office in Seattle, Wash, initiated a surveillance project with a dedicated team and database tracking the spread of severe acute respiratory syndrome coronavirus 2, deaths due to coronavirus disease 2019 (COVID-19), and deaths occurring within 28 days of COVID-19 vaccination. From January 2020 through July 2022, the results of 13,801 nasal/nasopharyngeal swabs from 7606 decedents tested for the virus were assembled in the surveillance database. Generally, 2 samples were collected and tested separately by 2 different laboratories. Positive rates increased from 5.7% in 2020 to 14.3% in 2022. Of 744 decedents positive for the virus, autopsies were performed on 418 (56%); of these, 106 (25%) died of COVID-19 as either the primary or a contributing cause. Comparison of autopsy findings of those dying of COVID-19 with those positive for the virus but dying of other causes demonstrated increased risk for those with preexisting conditions. Of 1035 deaths reported within 28 days of vaccination, the rates of thrombotic complications and myocarditis were no higher than in other decedents. This study provides evidence of the value to public health surveillance of an adequately resourced medical examiner office in tracking viral spread in the community, understanding disease mortality, and assessing vaccine safety.