Sexual assault/rape and serial sexual homicide: Clinical and investigative considerations.

The frequent absence of a documented history of sexual assault/rape in the prior research on serial sexual murderers is curious. In order to address several methodological problems in prior research, a closed-case archival review of a nonrandom national sample of 53 serial sexual homicide cases was conducted which identified 14 offenders with a history of sexual assault/rape for an overall prevalence rate of 26.4%. Of the 14 offenders with a prior known history of sexual assault/rape, 11 (78.6%) sexually penetrated at least one of their homicide victims at the crime scene. Implications for investigation of serial sexual homicide as well as for further understanding of this exceptionally rare crime are presented.

From intimate partners to serial killers: Nearly 40 years of female homicides in King County, Washington (1978-2016).

An extreme, known potential outcome of intimate partner violence (IPV) is death, with national data revealing females are more likely to be killed by intimate partners than by others. In a novel pairing, the King County Medical Examiner's Office data management system and the Washington State Attorney General's Office's Homicide Information Tracking System were retrospectively analyzed (1978-2016) with information gathered pertaining to female homicide victims. Analyses show that female victims commonly knew their assailant(s) (79.3%) who were overwhelmingly male (92.8%) and commonly intimate partners (31.4%). Disproportionately represented were Black (20.17%) and Native American (4.25%) females; Asian/Pacific Islander (2.5 times that of Whites) and elderly (24%) females among homicide-suicide deaths; and Asian/Pacific Islander and Hispanic females in cases of IPV. "Domestic violence" was the most cited motive (34.3%) and most assaults occurred in a residence (58.73%). Females under 10 years of age were most commonly killed by a parent or caregiver (42.86%), while those over 70 were most likely to be killed by a child (23.08%) or spouse (21.80%). Serial murders, most commonly by the Green River Killer (80%) but including others, accounted for at least 7% of deaths, with victims notably young and commonly sex workers (68%). As compared to males, females were more likely to be killed by multiple modalities, asphyxia, and sharp force, though IPV-related deaths were more likely to be associated with firearms. This study reinforces the vulnerability of females to IPV, sexual assault, and serial murders as well as to caretakers at the extremities of age.

The Health and Economic Impact of Youth Violence by Injury Mechanism.

INTRODUCTION: Violence is a leading cause of morbidity and mortality among U.S. youth. More information on the health and economic burden of the most frequent assault mechanisms-or, causes (e.g., firearms, cut/pierce)-can support the development and implementation of effective public health strategies. Using nationally representative data sources, this study estimated the annual health and economic burden of U.S. youth violence by injury mechanism. METHODS: In 2023, CDC's WISQARS provided the number of homicides and nonfatal assault ED visits by injury mechanism among U.S. youth aged 10-24 years in 2020, as well as the associated average economic costs of medical care, lost work, morbidity-related reduced quality of life, and value of statistical life. The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample provided supplemental nonfatal assault incidence data for comprehensive reporting by injury mechanism. RESULTS: Of the $86B estimated annual economic burden of youth homicide, $78B was caused by firearms, $4B by cut/pierce injuries, and $1B by unspecified causes. Of the $36B billion estimated economic burden of nonfatal youth violence injuries, $19B was caused by struck by/against injuries, $3B by firearm injuries, and $365M by cut/pierce injuries. CONCLUSIONS: The lethality of assault injuries affecting youth when a weapon is explicitly or likely involved is high-firearms and cut/pierce injuries combined account for nearly all youth homicides compared to one-tenth of nonfatal assault injury ED visits. There are numerous evidence-based policies, programs, and practices to reduce the number of lives lost or negatively impacted by youth violence.

Firearm-related suicides, homicides, and homicide-suicides involving security officers in two East African Countries: a press media review.

BACKGROUND: Firearm violence is a growing public health problem causing death globally. With easy accessibility to firearms, suicides, homicides, and homicide-suicides have increased among security officers, especially in developing countries affected by long-standing civil wars/political insurgencies. No study has explored firearm violence in East African countries. This study describes the press media reporting of suicides, homicides, and homicide-suicides among security officers in two East African countries (Uganda and Kenya). METHODS: Due to the absence of suicide databases among East African countries, the present study reviewed press media reports. We utilized content analysis of suicides, homicides, and homicide-suicides reports among security forces. Relevant media reports between January-2020 and May-2023 were searched. Using ANOVA and chi-square tests, we tested for statistical differences in characteristics between victims and perpetrators. RESULTS: Among the 56 perpetrated reports, most of them were homicides 44.64% (n = 25/56), 30.36% (n = 17/56) were homicide-suicides, and 25% (n = 14/56) were suicides. Perpetrators' age ranged from 21 to 47 years, majority being males [53/56 (94.64%)]. Victims were 58, mostly Ugandans [41/58 (73.21%)] with a mean age of 33.5 ± 8.81 years. Among the three main outcomes, statistically significant difference existed by country (χ2 = 23.88, p < 0.001), and perpetrators' age (F = 8.59, p = 0.005). There was a significant difference between perpetrators and the number of victims lost by age of victims (F = 10.37, p = 0.002). Among victims, type of security of perpetrator and citizenship of victims (χ2 = 24.18, p < 0.001) showed statistical difference with Ugandans having more victims to army officers while Kenyans to police officers. Brief incident descriptions pointed towards relationship dysfunctions, alcohol/substance abuse, intentional harm, and financial disagreements, as the potential causes. Only two perpetrators were reported to have mental health-related conditions. CONCLUSION: This study shows that media reported firearms-related suicides, homicides, and homicide-suicides among security forces commonly involve males. Perpetrators in Uganda are mainly army officers while in Kenya the perpetrators are mostly police officers. Mental health conditions were not frequently reported among perpetrators. We recommend strengthening and enforcing gun regulation policies among security officers to curb this growing problem in these countries. Routine screening of mental health problems to enable early interventions is recommended among security officers.

Trends in Mortality From Poisonings, Firearms, and All Other Injuries by Intent in the US, 1999-2020.

Importance: Although deaths due to external causes are a leading cause of mortality in the US, trends over time by intent and demographic characteristics remain poorly understood. Objective: To examine national trends in mortality rates due to external causes from 1999 to 2020 by intent (homicide, suicide, unintentional, and undetermined) and demographic characteristics. External causes were defined as poisonings (eg, drug overdose), firearms, and all other injuries, including motor vehicle injuries and falls. Given the repercussions of the COVID-19 pandemic, US death rates for 2019 and 2020 were also compared. Design, Setting, and Participants: Serial cross-sectional study using national death certificate data obtained from the National Center for Health Statistics and including all external causes of 3 813 894 deaths among individuals aged 20 years or older from January 1, 1999, to December 31, 2020. Data analysis was conducted from January 20, 2022, to February 5, 2023. Exposures: Age, sex, and race and ethnicity. Main Outcomes and Measures: Trends in age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined), age, sex, and race and ethnicity for each external cause. Results: Between 1999 and 2020, there were 3 813 894 deaths due to external causes in the US. From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries. Conclusions and Relevance: Results of this cross-sectional study suggest that from 1999 to 2020, death rates due to poisonings, firearms, and all other injuries increased substantially in the US. The rapid increase in deaths due to unintentional poisonings and firearm homicides is a national emergency that requires urgent public health interventions at the local and national levels.

337º Reunião Ordinária - 15 dez. 2022

Auditório Externo da Fiocruz Brasília, Avenida L3 Norte, Campus Universitário Darcy Ribeiro - Bloco educacional - Brasília/DF.

Violence-Related Death in Young Australians After Contact With the Youth Justice System: A Data Linkage Study.

Little is known outside of the United States about the risk of violence-related death among young people who have had contact with the youth justice system (justice-involved young people). We examined violence-related deaths among justice-involved young people in Queensland, Australia. In this study, youth justice records for 48,647 young people (10-18 years at baseline) who were charged, or experienced a community-based order or youth detention in Queensland, Australia (1993-2014) were probabilistically linked with death, coroner, and adult correctional records (1993-2016). We calculated violence-related crude mortality rates (CMRs) and age- and sex-standardized mortality ratios (SMRs). We constructed a cause-specific Cox regression model to identify predictors of violence-related deaths. Of 1,328 deaths in the cohort, 57 (4%) were from violence. The violence-related CMR was 9.5 per 100,000 person-years (95% confidence interval [95% CI] [7.4, 12.4]) and the SMR was 6.8 [5.3, 8.9]. Young Indigenous people had a greater risk of violence-related death than non-Indigenous people (cause-specific hazard ratio [csHR] 2.5; [1.5, 4.4]). Young people who experienced detention had more than twice the risk of violence-related death than those who were charged only (csHR 2.5; [1.2, 5.3]). We found that justice-involved young people have a risk of dying from violence that far exceeds that of the general population. The rate of violence-related death found in this study is lower than that in U.S.-based studies, which most likely reflects lower population level firearm violence in Australia. In Australia, young Indigenous people and those released from detention appear key groups to target for violence prevention efforts.

Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2020.

Problem/Condition: In 2020, approximately 71,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2020. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. Period Covered: 2020. Description of System: NVDRS collects data regarding violent deaths obtained from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2020. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (35 California counties, representing 71% of its population, and four Texas counties, representing 39% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results: For 2020, NVDRS collected information on 64,388 fatal incidents involving 66,017 deaths that occurred in 48 states (46 states collecting statewide data, 35 California counties, and four Texas counties), and the District of Columbia. In addition, information was collected for 729 fatal incidents involving 790 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 66,017 deaths, the majority (58.4%) were suicides, followed by homicides (31.3%), deaths of undetermined intent (8.2%), legal intervention deaths (1.3%) (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 deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known, suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black (Black) males experienced the highest homicide rate of any racial or ethnic group. 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. Homicide most often was 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, and the legal intervention death rate was highest among men aged 35-44 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When a specific type of crime was known to have precipitated a legal intervention death, the type of crime was most frequently assault or homicide. When circumstances were known, the three most frequent circumstances reported for legal intervention deaths were as follows: the victim's death was precipitated by another crime, the victim used a weapon in the incident, and the victim had a substance use problem (other than alcohol use).Other causes of death included unintentional firearm deaths and deaths of undetermined intent. Unintentional firearm deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and 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 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2020. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black male victims. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary circumstances for multiple types of violent death. Public Health Action: Violence is preventable, and states and communities can use data to guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. For example, the Colorado Violent Death Reporting System (VDRS), Kentucky VDRS, and Oregon VDRS have used their VDRS data to guide suicide prevention efforts and generate reports highlighting where additional focus is needed. In Colorado, VDRS data were used to examine the increased risk for suicide among first and last responders in the state. Kentucky VDRS used local data to highlight how psychological and social effects of the COVID-19 pandemic might increase risk for suicide, particularly among vulnerable populations. Oregon VDRS used their data to develop a publicly available data dashboard displaying firearm mortality trends and rates in support of the state's firearm safety campaign. Similarly, states participating in NVDRS have used their VDRS data to examine homicide in their state. Illinois VDRS, for example, found that state budget cuts were associated with notable increases in homicides among youths in Chicago. With an increase of participating states and jurisdictions, this report marks progress toward providing nationally representative data.

FOREWORD Finding Balance in the Fight Against Gun Violence.

The United States is distinct among high-income countries for its problem with gun violence, with Americans 25 times more likely to be killed by gun homicide than people in other high-income countries.1 Suicides make up a majority of annual gun deaths - though that gap is closing as homicides are on the rise - and the U.S. accounts for 35% of global firearm suicides despite making up only 4% of the world's population.2 More concerning, gun deaths are only getting worse. In 2021, firearm fatalities approached 50,000, the highest we have seen in at least 40 years.3 The increase in homicides in conjunction with lower crime overall further suggests an problem specifically with guns.4 As devastating as these deaths are, it does not come close to encompassing the mass toll of America's gun violence epidemic - a toll that disproportionately impacts people of color, with the Black community suffering at the highest rates. A broader and more accurate view of what constitutes gun violence must become a part of the national discourse if we are going to develop effective strategies to combat this crisis.5.

Sex Differences in Violent Death During Incarceration and Legal Intervention.

INTRODUCTION: This study clarifies the differences in death during incarceration and legal intervention between males and females, delineating the differences in demographic features and the circumstances of the violent death including location, injury pattern, and perpetrator. METHODS: The data used are from the National Violent Death Reporting System database from 2003 to 2019. All victims were either in custody, in the process of custody, or in prison. Sex was coded as female or male and as assigned at birth. All analyses were conducted using SAS 9.4 software using chi-square tests, with an alpha of 0.05 to test significant differences in the circumstances of mortality and demographic characteristics for each group. RESULTS: Our findings show that suicide was the most common cause of death during incarceration for both females and males (89.8% versus 77.4%; P < 0.001). Homicide was less common in females (1.6% versus 14.8%; P < 0.001) and legal intervention only occurred in males (2.2%; P < 0.001). Male victims were more likely to be of non-White race/ethnicity compared to females, while females were more likely to be experiencing homelessness, have documented mental illness, and comorbid substance abuse. CONCLUSIONS: Victim sex is significantly associated with circumstances of violent death among the incarcerated and highlights the need for appropriate mental health and substance abuse treatment.

Development of a Machine Learning Model to Estimate US Firearm Homicides in Near Real Time.

Importance: Firearm homicides are a major public health concern; lack of timely mortality data presents considerable challenges to effective response. Near real-time data sources offer potential for more timely estimation of firearm homicides. Objective: To estimate near real-time burden of weekly and annual firearm homicides in the US. Design, Setting, and Participants: In this prognostic study, anonymous, longitudinal time series data were obtained from multiple data sources, including Google and YouTube search trends related to firearms (2014-2019), emergency department visits for firearm injuries (National Syndromic Surveillance Program, 2014-2019), emergency medical service activations for firearm-related injuries (biospatial, 2014-2019), and National Domestic Violence Hotline contacts flagged with the keyword firearm (2016-2019). Data analysis was performed from September 2021 to September 2022. Main Outcomes and Measures: Weekly estimates of US firearm homicides were calculated using a 2-phase pipeline, first fitting optimal machine learning models for each data stream and then combining the best individual models into a stacked ensemble model. Model accuracy was assessed by comparing predictions of firearm homicides in 2019 to actual firearm homicides identified by National Vital Statistics System death certificates. Results were also compared with a SARIMA (seasonal autoregressive integrated moving average) model, a common method to forecast injury mortality. Results: Both individual and ensemble models yielded highly accurate estimates of firearm homicides. Individual models' mean error for weekly estimates of firearm homicides (root mean square error) varied from 24.95 for emergency department visits to 31.29 for SARIMA forecasting. Ensemble models combining data sources had lower weekly mean error and higher annual accuracy than individual data sources: the all-source ensemble model had a weekly root mean square error of 24.46 deaths and full-year accuracy of 99.74%, predicting the total number of firearm homicides in 2019 within 38 deaths for the entire year (compared with 95.48% accuracy and 652 deaths for the SARIMA model). The model decreased the time lag of reporting weekly firearm homicides from 7 to 8 months to approximately 6 weeks. Conclusions and Relevance: In this prognostic study of diverse secondary data on machine learning, ensemble modeling produced accurate near real-time estimates of weekly and annual firearm homicides and substantially decreased data source time lags. Ensemble model forecasts can accelerate public health practitioners' and policy makers' ability to respond to unanticipated shifts in firearm homicides.

Effects of Comprehensive Background-Check Policies on Firearm Fatalities in 4 States.

Despite promising results from individual-level studies, state-level studies of the effectiveness of comprehensive background-check (CBC) policies in reducing firearm fatalities have yielded null results in multiple states. These prior studies focused on CBC laws adopted in the 1990s, when record keeping was far less complete. We estimated the effect of the implementation of CBC policies on state-level firearm homicide and suicide rates in states implementing CBC policies from 2013 to 2015 (Colorado, Delaware, Oregon, and Washington). We compared age-adjusted firearm homicide and suicide rates, measured annually from 15 years prior to policy implementation until 2019, in each treated state to rates in control groups constructed using the synthetic control group method. Differences in firearm homicide rates for Colorado, Oregon, and Washington post treatment were all small (0.09 to 0.18 per 100,000 residents per year) and not well distinguished from natural variation. Oregon had on average 0.80 per 100,000 fewer firearm suicides per year than did synthetic Oregon post treatment. However, these results were inconsistent across modeling approaches and not well distinguished from natural variation. Our models produced poor fit for Delaware. Coupled with previous null results from Indiana, California, Maryland, Pennsylvania, and Tennessee, the present results suggest that extending background check requirements to private transfers alone and implementing these policies as is currently done is not sufficient to achieve significant state-level reductions in firearm fatalities.

Lethal Police Encounters and Cardiovascular Health among Black Americans.

This study uses insights from social stress theory to examine associations between exposure to police killings of Black Americans and cardiovascular health among Black women and men. Data on lethal police encounters come from the Mapping Police Violence (MPV) database, which allows for examination of total exposures to police killings of Black people and exposures to events when decedents were unarmed. MPV data are merged with the Behavioral Risk Factor Surveillance System (n = 26,086) and state-level information from multiple federal databases. Four cardiovascular health outcomes are examined-hypertension, diabetes, heart attack, and stroke. After adjusting for important risk factors, results from gender-stratified multilevel logistic regressions reveal a positive association between exposures to police killings of unarmed Black people and odds of hypertension among Black women and stroke among Black men. Total exposures to police killings of Black people are also associated with greater likelihood of stroke for Black men. Findings from this study demonstrate that stress exposures generated by the quantity and injustice of police killings have important implications for cardiovascular health among Black Americans. Furthermore, adverse cardiovascular health associated with exposure to police violence tends to manifest differently for Black men and women.

Trends in Homicide Rates for US Children Aged 0 to 17 Years, 1999 to 2020.

Importance: Homicide is a leading cause of death among children in the US. Objective: To examine trends in child homicide rates and characteristics most commonly associated with these deaths. Design, Setting, and Participants: In this cross-sectional study, the study team used National Vital Statistics System WONDER mortality data for 38 362 homicide victims aged 0 to 17 years for 1999 to 2020 and National Violent Death Reporting System data for child homicide victims for 2003 to 2019 in 45 states, Washington, DC, and Puerto Rico. WONDER data are based on death certificates for US residents. National Violent Death Reporting System data include characteristics of violent deaths, linking information from death certificates, and law enforcement, coroner, and medical examiner reports. Exposures: Child homicide was defined using underlying cause-of-death codes U01 to U02, X85 to Y09, and Y87.1 from the International Classification of Diseases, Tenth Revision, Clinical Modification. Main Outcomes and Measures: Trends in homicide rates per 100 000 children were tested using joinpoint regression analysis; differences in rates from 2019 to 2020 were evaluated using z tests. Circumstances of child homicides were described. Results: This study included 38 362 homicide victims (69.4% male). The overall child homicide rate (per 100 000 children) has increased annually, on average 4.3% since 2013, with a precipitous rise from 2019 to 2020 (2019 rate, 2.2; 2020 rate, 2.8; overall increase of 27.7%). Homicide rates recently increased significantly for boys (2018 rate, 2.9; 2020 rate, 4.1; overall increase of 16.1%), 6- to 10-year-olds (2014 rate, 0.5; 2020 rate, 0.8; overall increase of 5.6%), 11- to 15-year-olds (2018 rate, 1.3; 2020 rate, 2.2; overall increase of 26.9%), 16- to 17-year-olds (2018 rate, 6.6; 2020 rate, 10.0; overall increase of 19.0%), Black children (2012 rate, 5.9; 2018 rate, 6.8; 2020 rate, 9.9; overall increase of 16.6% from 2018 to 2020), Hispanic children (2014 rate, 1.6; 2020 rate, 2.2; overall increase of 4.7%), children in the South (2013 rate, 2.1; 2020 rate, 3.5; overall increase of 6.4%), and in rural (2011 rate, 1.8; 2020 rate, 2.4; overall increase of 3.2%) and urban areas (2013 rate, 1.9; 2020 rate, 2.9; overall increase of 4.4%). Since 1999, homicide rates have decreased for girls (1999 rate, 1.9; 2020 rate, 1.5; overall decrease of 1.4%), infants (1999 rate, 8.7; 2020 rate, 6.6; overall decrease of 1.3%), 1- to 5-year-olds (1999 rate, 2.1; 2020 rate, 1.8; overall decrease of 1.0%), Asian or Pacific Islander children (1999 rate, 2.0; 2020 rate, 0.5; overall decrease of 4.4%), White children (1999 rate, 1.5; 2020 rate, 1.3; overall decrease of 0.7%), and children in the Northeast (1999 rate, 2.0; 2020 rate, 1.7; overall decrease of 1.4%). Homicides of children 10 years or younger were most commonly precipitated by abuse/neglect, perpetrated by parents/caregivers. Homicides of 11- to 17-year-olds were most commonly precipitated by crime and arguments and perpetrated by someone known to them, especially friends and acquaintances. Conclusions and Relevance: The decline in homicide rates for some geographic and child demographic groups is encouraging; however, rates recently increased across several subpopulations, with some racial and ethnic disparities persisting for more than 20 years. More targeted strategies are needed to (1) protect 6- to 10-year-olds, 11- to 17-year-olds, and children in certain geographic areas and (2) urgently address firearm violence, racism, and inequities at the root of youth violence.

Race, structural racism and racial disparities in firearm homicide victimisation.

OBJECTIVES: To identify an approach in measuring the association between structural racism and racial disparities in firearm homicide victimisation focusing on racism, rather than race. METHODS: We examined associations of six measures of structural racism (Black/white disparity ratios in poverty, education, labour force participation, rental housing, single-parent households and index crime arrests) with state-level Black-white disparities in US age-adjusted firearm homicide victimisation rates 2010-2019. We regressed firearm homicide victimisation disparities on four specifications of independent variables: (1) absolute measure only; (2) absolute measure and per cent Black; (3) absolute measure and Black-white disparity ratio and (4) absolute measure, per cent Black and disparity ratio. RESULTS: For all six measures of structural racism the optimal specification included the absolute measure and Black-white disparity ratio and did not include per cent Black. Coefficients for the Black-white disparity were statistically significant, while per cent Black was not. CONCLUSIONS: In the presence of structural racism measures, the inclusion of per cent Black did not contribute to the explanation of firearm homicide disparities in this study. Findings provide empiric evidence for the preferred use of structural racism measures instead of race.

Comparison of US Firearm-Related Deaths Among Children and Adolescents by Race and Ethnicity, 1999-2020.

This study assesses racial and ethnic differences in overall burden of firearm-related mortality and in change in firearm-related mortality among youths from 1999 to 2020.

Homicides Involving American Indian and Alaska Native Individuals.

This Viewpoint discusses homicide rates among American Indian and Alaska Native individuals and the importance of utilizing existing strategies tailored to the needs of American Indian and Alaska Native communities to prevent violence and reduce these rates.

State Firearm Laws and Firearm-Related Mortality and Morbidity.

This Viewpoint highlights the challenges to passing federal legislation that limits gun ownership and accessibility and summarizes some of the state laws used to successfully lower rates of firearm-related death and injury.

Time trend and spatial distribution of the cases of lethal violence against women in Brazil. / Tendência temporal e distribuição espacial dos casos de violência letal contra mulheres no Brasil.

OBJECTIVE: to analyze the time trend and the spatial distribution of the cases of lethal violence against women in Brazil, according to age group and to race/skin color. METHOD: an ecological study of time series, with spatial distribution of the deaths of women victims of aggression, registered in the Mortality Information System, resident in Brazil, Brazilian geographic regions and states. Due to underreporting of deaths in some states, correction factors of the mortality rates were employed. For the trend analysis, we adopted the polynomial regression model. In addition to that, the mean rates and annual upward/downward trends were distributed considering the Brazilian federative units as analysis units. RESULTS: the mean rate was 6.24 cases of lethal violence per 100,000 women, with a significant variation across the Brazilian regions and states. The main victims of violent death in Brazil are young, black-/brown-skinned and indigenous women, with a growing trend in these population segments. The North and Northeast regions stood out with the most significant mean annual increases (0.33; r2= 0.96 and 0.26; r2= 0.92, respectively). CONCLUSION: there was a stable trend regarding lethal violence against women, with significant regional differences. Young, black-/brown-skinned and indigenous women are more vulnerable to violent death in Brazil.