Alaska ViolentDeath ReportingSystem2003 - 2008 August 2011State of AlaskaDepartment of Health and Social ServicesDivision of Public Health

William J. SteurCommissionerAlaska Department of Health and Social ServicesWard B. HurlburtDirector / Chief Medical OfficerDivision of Public HealthJoseph McLaughlinState Epidemiologist / ChiefSection of EpidemiologyReport Prepared by:Deborah Hull-Jilly, MPH, CLS – Principal InvestigatorWm. Scott Saxon, AK VDRS CoordinatorAdditional information pertaining to the Alaska Violent DeathReporting System (AK VDRS) and a link to the National ViolentDeath Reporting System (NVDRS) are available at revised publication includes correction of reported blood alcoholconcentration units from mg/dL to g/dL noted on pages ix, 7, 14, and21.This publication was supported by Grant #U17/CCU023102 from theCenters for Disease Control and Prevention. Its contents are solelythe responsibility of the authors and do not necessarily represent theofficial views of the Centers for Disease Control and Prevention.As additional data is collected and analyzed, supplemental reportswill be disseminated through the Section of Epidemiology website andpublications such as the Alaska Division of Public Health EpidemiologicBulletin.i


Table of ContentsAcknowledgements. ivAlaska Violent Death Reporting System Advisory Group. vExecutive summary. viiIntroduction. ixBackground On National Violent Death Reporting System . . ixAlaska Violent Death Reporting System Data Collection And Validation. ixStatistical Measures. xAlaska Regional Map. xiAK VDRS Definitions. xiHow to Use This Document. xiiiData Limitations. xiiiAdditional Data Resources. xiiiSection 1: Overview Of Violent Deaths.1Table 1.1:Victim Count, Percent, And Rate Of Violent Death By Demographics,Alaska, 2003-2008. 2Figure 1.1: Rate Of Violent Death By Age Group And Gender, Alaska, 2003-2008. 3Table 1.2:Victim Count, Percent, And Rate Of Violent Death By Gender, Race and EthnicityAlaska, 2003-2008. 4Figure 1.2: Weapons Involved In Violent Death, Alaska, 2003-2008. 5Figure 1.3: Primary Weapon Involved In Violent Death By Gender, Alaska, 2003-2008. 5Figure 1.4: Victim Count By Month And Manner Of Death, Alaska, 2003-2008. 5Table 1.5:Victim Count, Percent, And Rate Of Violent Death By Region, Alaska, 2003-2008. 6Figure 1.5: Victim Count Of All Violent Deaths By Region, Alaska, 2003-2008. 6Figure 1.6: Rate Of All Violent Deaths By Region, Alaska, 2003-2008. 7Other Frequent Characteristics. 7Section 2: Suicide.8Table 2.1:Victim Count, Percent, And Rate Of Suicide By Demographics, Alaska, 2003-2008. 9Figure 2.1: Rate Of Suicide By Age Group And Gender, Alaska, 2003-2008. 10Table 2.2:Victim Count, Percent, And Rate Of Suicide By Race, Ethnicity And Gender, Alaska,2003-2008. 10Figure 2.2: Weapons Involved in Suicide, Alaska, 2003-2008. 11Figure 2.3: Primary Weapon Involved In Suicide By Gender, Alaska, 2003-2008. 11Figure 2.4: Suicide Count By Month, Alaska, 2003-2008. 12Figure 2.5: Rate Of Suicide By Marital Status And Gender, Alaska, 2003-2008. 12Table 2.3:Victim Count, Percent, And Rate Of Suicide By Region, Alaska, 2003-2008. 13Figure 2.6: Suicide Count By Region, Alaska, 2003-2008. 13Figure 2.7: Suicide Count By Region, Alaska, 2003-2008. 14Frequent Suicide Characteristics, Alaska, 2003-2008. 14Section 3: Homicide.15Table 3.1: Victim Count, Percent, And Rate Of Homicide By Demographics,Alaska, 2003-2008. 16Figure 3.1: Rate Of Homicide By Age Group And Gender, Alaska, 2003-2005. 17Table 3.2: Victim Count, Percent, And Rate Of Homicide By Gender, Race And Ethnicity.Alaska, 2003-2008. 17Figure 3.2: Weapons Involved in Homicide, Alaska, 2003-2008. 18iii

Figure 3.3: Primary Weapon Involved In Homicide By Gender, Alaska, 2003-2008. 18Figure 3.4: Homicide Count By Month, Alaska, 2003-2008. 19Figure 3.5: Rate Of Homicide By Marital Status And Gender, Alaska, 2003-2008. 19Table 3.3:Count, Percent, And Rate Of Homicide By Region, Alaska, 2003-2008. 20Figure 3.6: Homicide Count By Region, Alaska, 2003-2008. 20Figure 3.7: Homicide Rate By Region, Alaska, 2003-2008. 21Frequent Homicide Characteristics, Alaska, 2003-2008. 21Section 4: Technical Notes.22NVDRS Methodology. 23Case Ascertainment. 24Weapons Categories. 24Calculating Rates. 24Figure 4.1: Alaska Violent Death Reporting System Data Collection And ValidationFlow Chart. 25Appendices.26Appendix A - About Alaska. 27Appendix B – Leading Causes Of Mortality In Alaska, 2004-2008. 29Appendix C - Child Fatality Review Overview. 30iv

AcknowledgementsThis report was prepared by the staff of the Injury SurveillancePrograms Unit, Section of Epidemiology, Division of Public Health,Alaska Department of Health and Social Services. Specialthanks to key data agencies and members of the AK VDRSAdvisory Group.Injury Surveillance and Prevention Programs Unit:Deborah Hull-Jilly, Unit Manager / Injury EpidemiologistWm. Scott Saxon, AK VDRS Project Coordinatorv

Alaska Violent Death ReportingSystem Advisory GroupAdrienne Bachman, AttorneyAlaska Dept. of Law310 K Street, Suite 520Anchorage, Alaska 99501Phone: (907) [email protected] Hull-Jilly, Principal InvestigatorAlaska DHSS, Section of IPEMS3601 C Street, Suite 222Anchorage, Alaska 99503Phone: (907) [email protected] Blumenstein, Program ManagerAlaska Native Tribal Health Consortium4000 Ambassador Drive, C-DCHSAnchorage, Alaska 99508Phone: (907) [email protected] James, Clin. Forensic Serv. Coor.Central Peninsula General Hospital250 Hospital PlaceSoldotna, Alaska 99669Phone: (907) 398-0544 or [email protected] Casto, Program ManagerAlaska Div. of Behavioral Health240 Main Street, Ste. 700Juneau, Alaska 99801Phone: (907) [email protected] Longoria, Program ManagerMOA-Interpersonal Violence Prevention825 L Street, Room 215Anchorage, Alaska 99519Phone: (907) [email protected] Cobb, CaptainAnchorage Police Department4501 Elmore StreetAnchorage, Alaska 99507Phone: (907) [email protected] Mallard, Colonel/Division DirectorAlaska State Troopers, DPS5700 East Tudor RoadAnchorage, Alaska 99507Phone: (907) [email protected] Fisher, Deputy DirectorAlaska Div. of Public Health3601 C Street, Suite 756Anchorage, Alaska 99503Phone: (907) [email protected] Markiewicz, SergeantAnchorage Police Department4501 Elmore StreetAnchorage, Alaska 99507Phone: (907) [email protected] Hamilton, Program OfficerAlaska Office of Children’s Services550 West 7th Avenue, Ste 1800Anchorage, Alaska 99501Phone: (907) [email protected] McKelvieUAA Criminal Justice Center3211 Providence DriveAnchorage, Alaska 99508Phone: (907) [email protected] Howell, Executive DirectorAlaska Injury Prevention Center3701 East Tudor, Suite 105Anchorage, Alaska 99507Phone: (907) [email protected] Morris, Asst. ProfessorSchool of Nursing – Univ. of Alaska3211 Providence Drive, PSB 103Anchorage, Alaska 99508Phone: (907) [email protected]

David ParkerAnchorage Police Department4501 Elmore StreetAnchorage, Alaska 99507Phone: (907) [email protected] Tugmon, LieutenantAlaska State Troopers, DPS5700 East Tudor RoadAnchorage, Alaska 99507Phone: (907) [email protected] Provost, DirectorAlaska Native Epi Center4000 Ambassador Drive, C-DCHSAnchorage, Alaska 99508Phone: (907) [email protected] Verbrugge, Chem. ManagerAlaska Public Health Laboratories5455 Dr. Martin Luther King Jr. AvenueAnchorage, Alaska 99507Phone: (907) [email protected] Raven, Chief Medical ExaminerAlaska DHSS, Medical Examiner’s Office5455 Dr. Martin Luther King Jr. AvenueAnchorage, Alaska 99507Phone: (907) [email protected] Walden, Research AnalystAlaska Bureau of Vital Statistics5441 Commercial BoulevardJuneau, Alaska 99811Phone: (907) [email protected] Rosay, Assoc. Prof/Int. DirectorUAA Criminal Justice Center3211 Providence DriveAnchorage, Alaska 99508Phone: (907) [email protected] Saxon, AK VDRS Program Coor.Alaska DHSS, Section of IPEMS3601 C Street, Suite 222Anchorage, Alaska 99503Phone: (907) [email protected] Sparks, CounselorWasilla High School701 E. Bogard RoadWasilla, AK 99654Phone: (907) [email protected] Strayer, Injury Prev. Spec.Alaska Native Tribal Health Consortium4000 Ambassador Drive, C-DCHSAnchorage, Alaska 99508Phone: (907) [email protected]

Executive SummaryThe Alaska Violent Death Reporting System 2003-2008 Summary report provides adetailed summary of six years of data concerning all types of violent deaths collectedby the Alaska Violent Death Reporting System (AK VDRS).The AK VDRS is a comprehensive, linked reporting system that collects andcentralizes information on violent deaths from a variety of sources. The AK VDRScreates a clearer picture of the circumstances related to violent deaths, aidingprevention efforts and policy development at the state and community levels. TheAK VDRS allows health officials to monitor suicides more accurately among specificpopulations, and better understand and possibly prevent suicides.The reportshows themajority ofviolent deathswere suicide.The AK VDRS captures information such as mental health treatment status, physicaland mental health problems and diagnoses, employment and financial status,relationship and emotional crisis, legal issues, and toxicological results of alcohol,antidepressants, and other drugs at the time of death. The data provides informationon an individual’s condition and mental state at death. It also provides a betterunderstanding of the personal and environment characteristics in order to developand implement prevention programs.AK VDRS collects data regarding violent deaths from death certificates, medicalexaminer reports, law enforcement reports and other health and legal documents.AK VDRS links multiple source data documents to enable prevention specialists tobetter understand each violent death. Prior to funding of the AK VDRS, single datasources provided limited information from which to understand patterns and thecircumstances surrounding violent deaths.The report shows the majority of violent deaths were suicide (64.5%), followed byhomicide (18.1%), violent death of undetermined intent (3.5%), unintentional firearmdeaths (2.8%), and legal intervention (1.0%). Other findings include:Overview of Deaths due to Violence In 2003-2008, there were 1347 violent deaths in Alaska, accounting for 7% ofall deaths in Alaska and a combined rate of 33.7 violent deaths per 100,000persons. Suicide accounted for the highest rate of violent death (21.7 per 100,000persons), followed by the combined rates for homicide/legal intervention (6.4 per100,000 persons) and undetermined intent and unintentional firearm deaths(5.5 per 100,000 persons, respectively). Highest rates by age group were found among children aged 1 year and adultsaged 20-29 years (84.0 and 59.9 per 100,000 persons, respectively).Suicide In 2003-2008, there were 869 suicides in Alaska, which account for nearlytwo-thirds (64.5%) of all violent deaths. Alaska’s suicide rate (21.7 per 100,000 persons) was almost three timeshigher than that for the lowest of the 17 participating NVDRS states. A higher proportion of suicide occurred in communities in the Northern andSouthwest regions of the State. The majority of suicides involved males (33.9 per 100,000 persons). Theoverall male suicide rate was nearly 4 times higher than the rate for females(9 per 100,000 persons) and was highest (69.4 per 100,000 persons) for malesbetween the ages of 20-29. Suicide was the fourth leading cause of death among Alaska Natives, wherehighest rates were among Native males (60.7 per 100,000 persons) andfemales (19.7 per 100,000 persons). Female decedents were nearly twice as likely to have a diagnosis or history oftreatment for mental illness (39.8%) compared to male decedents (21.7%). Current depressed mood was identified in 285 (32.8%) cases.viii

Of all suicides, 253 (29.1%) decedents left a suicide note. One-third disclosed their intent (270, 31.1%) of which less than half disclosedtheir intent in writing. Of the decedents tested for blood alcohol concentration (BAC), 292/360(77.9%) had a BAC of 0.08 g/dL (the legal limit in the majority of states).Homicide In 2003-2008, there were 244 homicides in Alaska. Homicide rate in males (8.0 per 100,000 persons) was higher than females (4.1per 100,000 persons), respectively. The majority of homicides involved males aged 20-39 years, where the highestrate was among males aged 20-29 years (15.7 per 100,000 persons). Homiciderates among females were higher than males for age groups 0-9 years and 70 . The highest rates were found among Black males (28.9 per 100,000 persons)followed by Alaska Native males (11.4 per 100,000 persons) and Asian/PacificIslander males (11.1 per 100,000 persons). Numbers of homicide were higher in the urban areas such as Anchorage/Mat-Su,however homicide rates were highest in the Northern and Southwest regions ofAlaska. Decedents who tested positive for alcohol (106/230), 87 (82.1%) showed a bloodalcohol concentration (BAC) of 0.08 g/dL (the legal limit in the majority ofstates).Weapons Half of all violent deaths involved a firearm (45.9%); poisoning accounted forone-fourth of all violent deaths (24.5%). The primary weapon in the majority of deaths among males was a firearm (633,62.6%). The primary weapon in the majority of deaths among females were similarlydistributed between firearm (88, 28.4%), poisoning (74, 23.9%), and hanging/strangulation/ suffocation (65, 21.0%).Location A residence (including a driveway, porch, or yard) was the most common place ofinjury (71.4%).Toxicology Testing for alcohol and drugs (prescribed and illicit) were conducted for 60% ofdecedents. Alcohol and marijuana were the most common substances testing positive(26.7% and 11.6%, respectively) among all decedents.Epidemiologic information from the AK VDRS has helped to target improvementsfor in-state forensic toxicological capabilities and strengthen public health and lawenforcement communications and infrastructure. Activities supported by AK VDRSinclude— Alaska Substance Abuse Epidemiologic Outcomes Workgroup Alaska Suicide Prevention Council Alaska’s Child Fatality and Child Death Reviews Alaska Native Tribal Health University of Alaska-Justice CenterAs additional data is collected and analyzed, supplemental reports will bedisseminated through the Section of Epidemiology website and publications such asthe Alaska Division of Public Health Epidemiologic Bulletin.ix

IntroductionBackground on National Violent Death Reporting System 1Violence against others or oneself is a major public health problem in the UnitedStates, claiming 50,000 lives each year. It is a particular problem for the young:homicide was the second and suicide was the third leading cause of death forAmericans 1 to 34 years of age in 2001.Given the importance of the problem, it is noteworthy that no national surveillancesystem for violence existed in the United States. In contrast, the federal governmenthas supported extensive data collection efforts. For example, during the past 30years critical details of fatal motor vehicle crashes about 40,000 deaths among U.S.residents annually. The result of that effort has been a better understanding of therisk factors for motor vehicle deaths – information that has helped to target safetyimprovements that have led to a significant decline in motor vehicle fatalities sincethe 1970s.Public health leaders and others were aware of the long-standing gap in informationsince 1989. In 1999, the Institute of Medicine recommended that CDC develop afatal intentional injury surveillance system. They supported the National ViolentInjury Statistics Systems (NVISS). NVISS has been administered by the HarvardInjury Control Research Center and includes 12 participating universities, healthdepartments and medical centers.In 2000, dozens of medical associations, suicide prevention groups, child protectionadvocates, and family violence prevention organizations joined a coalition whosepurpose was to secure federal funding to extend NVISS-like surveillance nationwide.Congress approved funding to start the new system, called the National Violent DeathReporting System (NVDRS), in fiscal year 2002. The first cooperative agreementswere established with six state health departments in September 2002, including:Maryland, Massachusetts, New Jersey, Oregon, South Carolina and Virginia.Additional funding to add more states was made available in fiscal year 2003 andanother seven states were funded (Alaska, Colorado, Georgia, North Carolina,Oklahoma, Rhode Island and Wisconsin). Although Alaska was not a first-yearstate, it voluntarily collected 2003 data as a first year NVDRS state. Today NVDRSoperates in 18 states including Kentucky, Michigan, Ohio, New Mexico and Utah.Alaska Violent Death Reporting System Data Collection andValidationUsing NVDRS guidelines, violent deaths are initially identified on the basis ofInternational Classification of Diseases, Tenth Revision (ICD-10) codes for theunderlying cause of death field on death on the death certificate. All suicides,homicides, deaths of undetermined intent, deaths due to legal intervention, andunintentional firearm deaths that occurred in Alaska between January 1, 2003 andDecember 31, 2008 were included. The grouping of ICD-10 codes can be found inSection 4: Technical Notes.The Alaska Bureau of Vital Statistics (AK BVS) mortality database is queriedquarterly for ICD-10 codes matching NVDRS guideline and a list of death certificatenumbers are sent to the AK VDRS Program Coordinator. In addition, a manualreview is conducted quarterly by the Program Coordinator.Demographic information on the death certificate may be completed by a funeral home1 Centers for Disease Control and Prevention. National Violent Death Reporting System (NVDRS). (2003).National Center for Injury Prevention and Control, Centers for Disease Control and Preventionhttp//:

director using information provided by the victims family or other concerned parties.Either a physician certifying the death or a medical examiner completes the cause andmanner of death on the death certificate. Since death certificate information is notelectronically imported to AK BVS, all original certificates are sent to the AK BVS forregistration and entry into the state’s database.The abstractor reviews key fields on each death certificate including manner ofdeath, description of injury (place, time, location, and associated text), and all causesleading to death. The process ensures that all deaths rotationally meeting theNVDRS case definition are identified. A record is created in the AK VDRS database,and additional information is subsequently added from medical examiner and lawenforcement sources. The State Medical Examiner’s Office (SMEO) provides autopsyreports, toxicology results, hospital records, and other pre-hospitalization information.Law enforcement documents include trooper and police reports and weapon (includingballistics) reports from the Alaska Scientific Crime Laboratory. Newspaper articlesare also collected, but the information is not coded and used as a mechanism toidentify potential victims and suspects.Over 270 data elements may be collected for each incident in the database, includinginformation on the following when applicable: the incident, the victim, the suspect(s),toxicology, weapon(s), circumstances associated with a homicide or suicide,relationship between a victim and suspect(s), and the relationship between a victimand weapon(s).Ten percent of all death certificates undergo a second independent abstraction tovalidate accuracy of data entry into the AK VDRS database. Errors identified onthe death certificate are reported back to the SMEO and AK BVS with a requestfor review and correction. The corrected information is entered into the AK VDRSdatabase only after corrective action is taken by these offices and notice is sent back tothe AK VDRS Program Coordinator.Statistical MeasuresThe AK VDRS identified 1347 decedents whose deaths occurred between January 1,2003 and December 31, 2008. Some of the NVDRS incident types are not included asoptions on a standard death certificate. This summary report categorically organizedinformation meeting the NVDRS case definitions and used the abstractor’s assignedmanner of death for analytical purposes.Three measures are used to summarize violent deaths: counts, percentages, andrates. Simple counts represent the most basic measure of violent death and areimportant for quantifying the problem, while percentages offer a way of showingdistributions in the underlying population relative to some factor of interest, such asage or gender. Rates add an additional level of detail by taking into account the size ofthe underlying population and facilitating comparisons between groups. Age-adjustedrates were not calculated. The crude rates provide the true rate of injury within apopulation, which is important for proper community-level prevention strategies.Death rates are expressed as the number of deaths per 100,000 persons. Refer tothe Technical Notes section for detailed information on population estimates usedfor calculating rates. Rates were calculated for specific demographic group (i.e., age,gender, marital status), as well as by region. Event characteristics were noted onlyas being present. To ensure results incorporated all affirmations, data were analyzedusing crosstab analysis to incorporate information from both law enforcement andmedical examiner reports.xi

Alaska Regional estGulf CoastAK VDRS DefinitionsData year – The data year is the calendar year in which the victim died.Homicide – The killing of one human being by the act, procurement, or omissionof another. A death resulting from the intentional use of force or power, threatenedor actual, against another person, group, or community, where a preponderance ofevidence must indicate that the use of force was intentional. Included are deathswhen the suspect intended to only injure rather than kill; fatal heart attacksinduced from the force or power; unintentional discharge of a firearm when usedto control or frighten; “justifiable homicides” not committed by a law enforcementofficer (see Legal intervention death); deaths resulting from self-defense; deaths dueto “child or elder abuse” without an intent being specified; and deaths due to neglectby one person against another.Homicides do not include hunting accidents (see Unintentional firearm deaths) orcombat related deaths under operation of war. Vehicular homicide is not includedunless there is a preponderance of evidence of intent to use force against another.Legal intervention death – A death where the victim is killed by a law enforcement(and military police) officer acting in the line of duty.Natural death – A death which occurs by the unassisted operation of naturalcauses, as distinguished not only from “civil death”, but also from “unnatural” (e.g.violent) death.Suicide – The deliberate termination of one’s own life. A death resulting from theintentional use of force against oneself with a preponderance of evidence to indicatethe force was intentional.Suspect – A person reputed or suspected to be involved in a crime. A person who issuspected of having killed another person in an incident.Terrorism-related death – “Act of terrorism” means an activity that involves aviolent act or an act dangerous to human life that is a violation of the criminalxii

laws of the United States or of any State, or that would be a criminal violation ifcommitted within the jurisdiction of the United States or of any State. Terrorismrelated deaths are homicides or suicides that result from an act of terrorism and area mechanism of death rather than a manner of death.Undetermined manner of death – A death for which the evidence indicatingone manner of death is no more compelling than the evidence indicating anothermanner of death.The AK VDRS (NVDRS) operational definition used in case ascertainment is adeath resulting from the use of force or power against oneself or another person forwhich the evidence indicating one manner of death is no more compelling than theevidence indicating another manner of death.Death caused byviolent externalmeans, asdistinguished fromnatural death ascaused by diseaseor the wasting ofthe vital forces.Unintentional firearm injury death – The term “firearm” means any weapon whichis designed to or may readily be converted to expel any projectile by the action of anexplosive. Intent refers only to the state of mind of which an act is done purposely,and not accidentally.The AK VDRS (NVDRS) operational definition used in case ascertainment is adeath resulting from a penetrating injury or gunshot wound from a weapon thatuses a powder charge to fire a projectile when there was

UAA Criminal Justice Center 3211 Providence Drive. Anchorage, Alaska 99508 Phone: (907) 786-1810. [email protected] Angelia Morris, Asst. Professor School of Nursing – Univ. of Alaska 3211 Providence Drive, PSB 103. Anchorage, Alaska 99508 Phone: (907) 786-4693. [email protected]