Missouri Violent Death Reporting System | Missouri Department of Health and Senior Services

If you or someone you know is struggling or dealing with a crisis, help is available. Call or text 988 or visit the 988 Lifeline to chat or for more information or education. Find out where you can get naloxone here: Where to Get Naloxone.

Find where you can get Naloxone

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

	Suicide		Homicide
2018	MOVDRS 1,232	Vital Stats 1,230	MOVDRS 657	Vital Stats 657
2019	1,165	1,130	619	623
2020	1,139	1,125	806	802
2021	1,170	1,174	706	716
2022	1,227	1,214	721	740

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

Sources

U.S. Bureau of Labor Statistics

CDC Wonder

WISQARS

Violent Death Dashboard

Tableau Suicide Dashboard

Suicide Dashboard

Homicide Dashboard