Too many or too few unintentional firearm deaths in official US mortality data?
Too many or too few unintentional firearm deaths in official US mortality data?
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DOI：
10.1016/j.aap.2010.10.018
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发表时间：
2011-05-01
影响因子：
5.9
通讯作者：
Hemenway, David
中科院分区：
文献类型：
--
作者：
Barber, Catherine;Hemenway, David
我们检验了美国非故意枪支致死数据的准确性。我们从国家暴力死亡报告系统（NVDRS）的数据入手，检查了由NVDRS任何数据源——NVDRS摘录员、州生命统计登记处（即国际疾病分类第十版根本死因编码以及死亡证明上的死亡方式）、法医或验尸官报告以及警方补充杀人报告——所报告的每一起被列为意外的枪支致死事件。在仔细阅读了所有来源的信息之后，我们依据NVDRS的定义将每个案例归类为非故意或故意。将我们的分类与NVDRS摘录员的分类进行比较，我们得出结论：NVDRS数据能准确报告非故意枪支致死情况（敏感度为98%；阳性预测值[PPV]为99%）。然后我们根据国际疾病分类第十版根本死因编码将我们的分类与州生命统计登记处的分类进行比较，发现存在很大的不准确之处（敏感度为62%；PPV为58%）。38%的真实案例被遗漏，42%的报告案例为假阳性。正如先前文献所报道的，超过一半由他人造成的非故意枪击事件被归类为杀人案，而非意外事件。这对于年轻受害者的数据来说是一个特别的问题。然而，出乎意料的是相反的问题：我们发现许多明确的自杀和杀人事件被报告为意外。我们认为这是由于国际疾病分类第十版在死亡方式为“待定”或空白时将伤害致死归类到“意外”类别的编码做法。最后，在州一级层面，我们将每个州和每年的总体结果与官方的国家生命统计系统数据（在美国疾病控制与预防中心的WONDER网站上报告）进行了比较。我们发现那里存在更严重的非故意枪支致死数据过度报告的证据。对于“官方死亡率数据中非故意枪支致死数量是过多还是过少？”这个问题，最好的答案是“两者皆有”。许多真实的意外事件被遗漏，同时许多自杀和杀人事件被错误地报告为意外。相比之下，NVDRS对非故意枪支致死的案例定义应用得一致且准确。（C）2010爱思唯尔有限公司。保留所有权利。
We examined the accuracy of data on unintentional firearm fatalities in the United States. We began with data from the National Violent Death Reporting System (NVDRS) and examined every firearm death reported as an accident by any NVDRS data source - the NVDRS abstracter, the State Vital Statistics Registry (i.e., the ICD-10 Underlying Cause of Death code and manner of death from the death certificate), the medical examiner or coroner report, and the police Supplementary Homicide Report. After carefully reading the information from all sources, we then classified each case as either unintentional or intentional using NVDRS definitions.Comparing our classification with that of the NVDRS abstracter, we conclude that NVDRS data accurately report unintentional firearm deaths (sensitivity 98%; positive predictive value [PPV] 99%). We then compared our classification with that of the State Vital Statistics Registry based on the ICD-10 Underlying Cause of Death code and found great inaccuracy (sensitivity 62%; PPV 58%). Thirty-eight percent of true cases were missed and 42% of reported cases were false positives. As has been previously reported in the literature, over half of unintentional shootings that were inflicted by another person were classified as homicides, not accidents. This is a particular problem for the data on young victims. What was unexpected, however, was the opposite problem: we found many unambiguous suicides and homicides that were reported as accidents. We believe this is due to the ICD-10 coding practice of assigning injury deaths to the "accident" category when manner of death is "pending" or left blank.Finally, at the state-level, we compared our overall results for each state and year with the official National Vital Statistics System count (reported on CDC's WONDER website). We found evidence of even greater over-reporting of unintentional firearm deaths there.In answer to the question, "Are there too many or too few unintentional firearm deaths in official mortality data?" the best answer is, "Both." Many true accidents are missed, while many suicides and homicides are mistakenly reported as accidents. By contrast, the NVDRS applies a case definition for unintentional firearm deaths with consistency and accuracy. (C) 2010 Elsevier Ltd. All rights reserved.