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The Missouri Violent Death Reporting System (MOVDRS) is the CDC-funded program at Missouri Department of Health and Senior Services responsible for collecting information about violent deaths in the state. Violent death includes suicides, homicides, accidental firearm deaths, and any death in which intent could not be determined but violence is suspected. Violent death is a significant public health problem in Missouri, with the state having the 12th worst violent death rate in the country in 2023. The MOVDRS staff work with coroners/medical examiners and law enforcement agencies across the state to collect detailed information about these violent deaths, and the following MOVDRS data aim to provide a clearer understanding of the circumstances around violent death to aid communities in prevention.

Introduction

Violence is recognized as a significant public health problem that can be prevented with appropriate interventions. In 2023, violence claimed the lives of over 80,000 people in the U.S. Tragically, more than 60% of violent deaths are attributed to suicide in the U.S. each year. In 2023, Missouri had a violent death rate of 31.5 per 100,000 population, and that rate increased 23% compared a decade prior. This ranks Missouri as the 12th highest violent death rate in the U.S.

Suicide is a significant component of violent death, with the manner comprising almost 60% of all Missouri resident violent deaths. Even with the high percentage of suicide deaths, Missouri has a notably high rate of homicide, ranking as the ninth highest homicide rate in the U.S. in 2023. Of particular concern is the effect of violent death on Missouri youth and young adults. Homicide was the second leading cause of death and suicide was the third leading cause of death amongst all children (from birth through age 18) in Missouri in 2023. For young adults (ages 19-24) in Missouri, suicide was the second leading cause of death and homicide was the third leading cause of death in 2023.

The Missouri Violent Death Reporting System (MOVDRS) is program funded by a Centers for Disease Control and Prevention (CDC) grant awarded to Missouri beginning September 1, 2016. MOVDRS compiles facts from a variety of reports into a usable, secure, anonymous violent death database with the goal of providing prevention programs and communities with a clear understanding of the circumstances surrounding violent deaths to guide local decisions about efforts to prevent violence and track progress over time. MOVDRS is primarily housed within the Missouri Department of Health and Senior Services (DHSS) with a small team at the Missouri State Highway Patrol (MSHP).

Data Collection

MOVDRS identifies cases by reviewing death certificate data. The National Center for Health Statistics adds cause of death codes to the death certificates using the International Classification of Diseases, 10th Revision (ICD-10), and MOVDRS uses these cause of death codes to identify violent deaths. The following ICD-10 codes are used:

• Suicide: X60-X84, Y87.0, U03
• Homicide: X85-X99, Y00-Y09, Y87.1, U01-U02
• Undetermined Intent: Y10-Y34, Y87.2, Y89.9
• Accidental Firearm: W32-W34, Y86
• Legal Intervention (excluding executions): Y35.0-Y35.4, Y35.6-Y35.7, Y89.0

Occasionally deaths are identified through partnerships with coroners/medical examiners (CMEs) and law enforcement (LE) before they are identified through death certificates; death certificate information is added when it becomes available. Once identified, MOVDRS staff reach out to the appropriate CME and LE agency to request reports for the death and the incident leading up to the death. Staff then read through the reports to gather the relevant information and enter it into a secure, de-identified CDC-hosted database.

Unlike most public health data systems, NVDRS jurisdiction is determined by the place of fatal injury rather than the place of residence or the place of death. For example, a Missouri resident who is violently fatally injured in Illinois would be counted as a Missouri resident death by vital statistics sources but would be included in the Illinois Violent Death Reporting System rather than MOVDRS. This applies to both state-level and county-level jurisdictions. Due to this, death counts from MOVDRS can differ slightly from those offered through vital statistics sources such as the Missouri Public Health Information Management System (MOPHIMS). Statewide comparisons are listed below for reference.

Annual Number of Missouri Deaths by Data System and Manner of Death

While there can be overlap, the different sources (death certificates, CME reports, and LE reports) often provide different pieces of information. While typically all reports will include basic demographic information, more detailed demographics such as education level, occupation, and veteran status typically come directly from the death certificates with occasional updates from the other sources. LE reports are the primary source for information on suspects for homicides as well as for any detailed information on weapon/mechanism. CME reports are the sole source for toxicology testing, although some substance information is often available from the death certificate. Information about circumstances can come from any of the three sources but are most likely to come from the CME and LE reports and reflect information provided to CME and LE officials by friends, family, and acquaintances of the decedent as well as any witnesses to the fatal injury and any relevant professionals (such as other LE agencies, doctors/hospitals, Child Protective Services (CPS), etc.). In homicide cases, all circumstance and toxicology information pertain to the victim, not the suspect, unless otherwise noted.

Circumstance information is divided into categories: manner-specific, mental health/substance misuse, and life stressors/crime. Suicide-specific circumstances are those that only pertain to suicides, such as the decedent leaving a suicide note. Homicide-specific circumstances are those that only pertain to homicides, such as the death was caused by a drive-by shooting. Mental health/substance misuse circumstances are collected for both those who died by suicide and those who died by homicide, and includes information about diagnosed mental health conditions, substance misuse issues, and any treatment associated with mental health conditions and/or substance misuse issues. Mental health/substance misuse circumstance information is collected to provide potential points of intervention for prevention programs and authorities. It is not intended to stigmatize those who have mental health conditions or substance misuse issues or to stereotype those individuals. Life stressors/crime circumstances apply to both suicide and homicide deaths and are those circumstances that relate to relationships, everyday life, and criminal situations that appear to have played some role in the death.

Data Limitations

Data available through MOVDRS are limited by the availability and completeness of reports provided through our CME and LE partners. There is no standardization of CME and LE reports surrounding violent deaths, which adds to the time it takes to accurately collect the data from the reports. There is also no requirement for CME offices and LE agencies to work with MOVDRS. The program is incredibly grateful to those offices and agencies who provide reports, and staff are always looking for ways to help new jurisdictions join the program.

Of particular note is the difference in levels of toxicology testing across the state. While coroners will frequently only conduct toxicology testing on suspected overdoses, particularly when the substances are unknown, MEs will usually run toxicology tests on the majority of deaths they certify. This is often due in part to the extreme funding limitations the coroners face. MOVDRS, therefore, receives toxicology information at a significantly higher rate from urban areas where MEs have jurisdiction.

In the 2022 data year, MOVDRS received LE reports for 89% of all violent deaths, CME reports for 69% of violent deaths, both reports for 61% of violent deaths, and at least one report for 99% of violent deaths. A further encouraging factor is that 89% of violent deaths in 2022 had at least one report with information on the circumstances surrounding the death. This indicates that while there may still be some missing information, the vast majority of violent deaths are represented in the circumstance-related data. This dataset is unique to NVDRS programs and is not available in its entirety in any other program or system in Missouri.

Toxicology

As previously mentioned, toxicology information comes exclusively through the CMEs, whether through their reports or through the death certificate. The listed substances are those for which the decedent tested positive, whether or not the use of the substance was illicit. For example, the amphetamines category includes instances of both the decedent using an amphetamine as prescribed by a physician (no substance misuse) or the decedent either using a prescribed amphetamine incorrectly or using methamphetamine (illicit). The toxicology reports generally do not distinguish between prescribed and non-prescribed substances unless the substance in question does not have the option to be prescribed (alcohol, heroin, cocaine, PCP, etc.).

The reports also do not always indicate if substances were used prior to or around the time of fatal injury or if they were used after injury but before death. For example, a report of opiates on a toxicology report does not necessarily indicate that the decedent had taken opiates around the time of the injury or that the opiates were related to the cause of death. If the decedent had been hospitalized between the time of injury and time of death and no specimens from the time of admission were available, it’s very possible that substances in the decedent’s system at the time of death could have been introduced through surgery or other treatment and are not indicative of the circumstances surrounding the injury.

Toxicology information, therefore, must be interpreted with caution. Any substances may or may not be related to the fatal injury and may or may not be indicative of substance misuse. The toxicology information is included to provide prevention programs and decision makers with as much potentially useful information as possible.

Data Definitions

• Weapon type/mechanism is based on the primary weapon used to inflict the fatal injury. When multiple weapon types are used, the weapon type is based on the weapon that was used to cause the fatal injury.
• Injury location: the type of place at which the fatal injury occurred regardless of where the death occurred. For example, if a decedent was fatally injured in their residence, was transported to the hospital, and died there, the injury location would be the house or apartment rather than the hospital.
• Victim’s own residence: the decedent was fatally injured at their own residence. This can include any part of the decedent’s property such as driveway, garage, parked motor vehicle in the driveway/garage, porch, yard, pool, shed, and any part of the residence itself. It does not include any areas of working farm, work buildings, or roads, streets, or alleys surrounding the residence. This applies to any residence the decedent owns or permanently resides at, including vacation or second homes. This does not include instances where the decedent resided in an institutional setting (jail, mental health facility, long-term care facility, etc.).
• Occupational groups are based on the Standard Occupation Classification (SOC) major groups and are generated in partnership between the CDC and the National Institute for Occupational Safety and Health (NIOSH), who uses the free-text industry and occupation fields from the NVDRS dataset to match with occupational groupings. While imperfect, estimated rates for each grouping were created using Occupational Employment and Wage Statistics (OEWS) data from the U.S. Bureau of Labor Statistics for each corresponding year. Military workforce data were not available in the OEWS and so were therefore omitted from rate calculation. This variable does not include individuals who were not in the workforce at the time of death (unemployed, retired, homemaker, student, etc.).
• Top 8 occupational groups are calculated using the total death count.
• Veteran status: the decedent had ever served in the U.S. Armed forces. It is likely that the number of veterans is underreported in the system, as it relies on the knowledge of and reporting by friends and family of the decedent. Unless there is information from friends, family, or paperwork found at the scene, the decedent is often labeled as a non-veteran.
• Known circumstances: the case reports included at least one piece of information about the circumstances surrounding the death. Note that all other circumstance variable percentages are calculated using deaths with known circumstances as the denominator. For example, the suicidal thoughts history variable is the number of decedents with a history of suicidal thoughts as a percentage of suicide deaths with any known circumstances. Written as a formula: (deaths with given circumstance ÷ deaths with any known circumstances) x 100.
• Suicidal thoughts history: the decedent had previously expressed suicidal thoughts or plans whether in verbal, written, or electronic form. The disclosure of suicidal thoughts or plans does not have to occur near the time of the death and could have occurred any time in the decedent’s life.
• Suicide attempt history: the decedent had a history of suicide attempt(s) before the fatal incident whether or not the attempts resulted in physical injury.
• Disclosed intent: the decedent disclosed their suicidal thoughts or plans near the time of their death (within one month), but there must have been enough time prior to the death for intervention to be possible; this does not include instances where the decedent expressed intent at the moment of the suicide. The disclosure of intent can include verbal, written, and electronic communications.
• Left suicide note: the decedent left a suicide note or some other form of communication with the intention that the message be found after their death. The notes can be written, verbal (such as a voicemail), or electronic (such as an email or social media message).
• Physical health problem: the decedent’s physical health problems appear to have contributed to the death. This could include terminal diseases, debilitating conditions, and chronic or acute pain.
• Legal problem: the decedent was experiencing criminal or civil legal problems which appear to have contributed to the death. A criminal legal problem could include recent or impending arrest, law enforcement pursuit, or impending criminal court date. A civil legal problem could include divorce, custody dispute, or civil lawsuit.
• Job problem: the decedent had job-related problems that appear to have contributed to the death. This could include problems at work (tensions with a coworker or boss, poor performance reviews, feared layoff, etc.) or problems related to joblessness (recently laid off, having difficulty finding a job, etc.).
• Financial problem: the decedent had financial problems (independent of job problems) that appear to have contributed to the death. This could include bankruptcy, overwhelming debts, or foreclosure of a home or business.
• Depressed mood: the decedent was perceived by self or others to be depressed at the time of the injury. There does not need to be a clinical diagnosis, and there does not need to be any indication that the depressed mood directly contributed to the death.
• Mental health problem: the decedent had a diagnosed mental health condition, whether or not the condition appeared to directly contribute to the death. This includes disorders and syndromes listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with the exception of alcohol or other substance dependence. Examples of qualifying disorders and syndromes include major depression, schizophrenia, generalized anxiety disorder, autism, attention-deficit/hyperactivity disorder (ADHD), eating disorders, personality disorders, and Alzheimer’s or dementia.
• Current mental health treatment: The decedent was receiving mental health or substance misuse treatment at the time of death. This includes but is not limited to seeing a psychiatrist, psychologist, medical doctor, therapist, or other counselor, receiving a prescription for medication related to a mental health condition or substance misuse, attending relevant classes, residing in an inpatient, group home, or halfway house facility for mental health or substance misuse problems, or attending alcohol or narcotics anonymous.
• History of treatment: The decedent had ever been treated for mental health or substance misuse problems, whether at the time of death or previously.
• Alcohol problem: The decedent was perceived by self or others to be addicted to or have a problem with alcohol whether or not the alcohol problem directly contributed to the death.
• Non-alcohol substance problem: The decedent was perceived by self or others to be addicted to or have a problem with any substances other than alcohol whether or not the substance problem directly contributed to the death. These substances can include illicit drugs, prescription medications, and other substances such as inhalants.
• Intimate partner problem: The decedent was having problems with a current or former intimate partner, and those problems appear to have contributed to the suicide or undetermined intent death. Problems can include divorce/break-up, arguments, jealousy, or other conflict, and the decedent can be the aggressor, receiver, or both in these problems. This variable is used exclusively for suicides and undetermined intent deaths.
• Intimate partner violence: The decedent died by homicide due to immediate or ongoing conflict or violence between current or former intimate partners. This includes many different situations such as:
• The decedent was killed by a current or former intimate partner.
• The decedent was killed by their partner’s new or former intimate partner (e.g. ex-husband kills his ex-wife’s new boyfriend) or the person their partner is having an affair with.
• The decedent was a bystander or other person killed during intimate partner violence. This can include an individual intervening in an intimate partner violence situation, an individual retaliating after an intimate partner violence incident (e.g. a child kills their mother’s boyfriend after finding out the boyfriend assaulted the mother), or any other individuals killed related to the incident (e.g. a boyfriend kills his girlfriend’s child because he is angry at her).
• The decedent was the perpetrator of intimate partner violence and was killed by law enforcement.
• For this circumstance to apply, there must be either a current mutual romantic or intimate relationship or history of mutual romantic or intimate relationship. Instances of one-sided romantic or intimate relationship interest (unrequited love) are not included. Instances of sex/intimacy being exchanged for money, drugs, or other goods are also not included. This variable is used exclusively for homicide and legal intervention deaths.
• Family relationship problem: The decedent had a problem with a family member (other than intimate partner) and the problem appeared to have contributed to the death. These are often arguments or fights but can include instances of abuse.
• Known to local authorities (person and household): Either the decedent or their household had contact with local authorities, with or without any arrests. Authorities can include law enforcement, EMS, child protective services, public safety officers, and judges. Being known to authorities may or may not involve direct contact on the part of the decedent.
• Argument: A specific argument or verbal conflict appears to have led to the death. This includes instances where a verbal argument escalated to a physical fight.
• Precipitated by another crime: There was a serious crime such as drug dealing, robbery, assault, or rape leading up to the death. This can include cases where the decedent was a victim in another serious crime and cases where the decedent was the perpetrator in another serious crime.
• Other crime was in progress: The precipitating crime was in progress at the time of the death.
• Drive-by shooting: The homicide victim was killed in a shooting where the suspect or group of suspects drives near the victim and shoots while driving or uses a car to approach and flee the scene of the homicide but steps out of the car just long enough to use a weapon.
• Drug involvement: Drug dealing, drug trade, or drug use is suspected to have played a role in a homicide death, whether or not the victim was involved with the drugs (e.g. bystander, law enforcement).
• Jealous: Distress over a current or former intimate partner’s relationship or suspected relationship with another person led to the incident. This does not apply to individuals who were killed in the incident but were not part of the love triangle/jealousy situation (e.g. child, bystander, law enforcement, etc.).
• Justifiable self-defense: A homicide or legal intervention death was committed by a law enforcement officer in the line of duty or was committed by a civilian in legitimate self-defense or in defense of others. This information often comes from police reports.
• Victim used weapon: The homicide victim also used or brandished a weapon during the fatal incident.
• Fight: Immediately before the death there was a physical fight between two individuals which led to the death of individuals involved in the fight, bystanders, or individuals trying to stop the fight. While a verbal argument often precedes a fight, it is not a requirement.

Sources

U.S. Bureau of Labor Statistics: https://www.bls.gov/oes/tables.htm

CDC Wonder: https://wonder.cdc.gov/deaths-by-underlying-cause.html

WISQARS: https://wisqars.cdc.gov/