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• W2327777488 abstract "Homicide is among the six leading causes of death for those between the ages of 1 and 44, and accounts for approximately 18,000 deaths annually in the United States.1 The majority of homicides are committed by persons known to the victim.2 Approximately one in three homicides of females is committed by current or former spouses or boyfriends, a group collectively referred to as intimate partners.3 Among male homicide victims, five percent are killed by intimate partners. Unlike other causes of death, intimate partner homicides cannot be described by using death certificate information because death certificates do not record the victim's relationship to the perpetrator. This report summarizes information regarding intimate partner homicides that occurred in the United States during the period from 1981 through 1998, and is based on supplemental homicide reports collected by the Federal Bureau of Investigation as part of their Uniform Crime Reporting System. Supplemental homicide reports are filed voluntarily by police departments for homicides occurring within their jurisdiction, and include demographic variables regarding victims and perpetrators, their relationship, and any weapon used. Intimate partner homicide rates among white females decreased 23%, and rates among white males decreased 62% The database contains reports completed by police departments throughout the United States. Submission of crime data to the FBI is voluntary, and the system does not capture all homicides. The true number of homicides can be estimated by comparing FBI homicide counts with homicide counts from CDC's National Center for Health Statistics. This report uses FBI supplemental homicide report data, adjusted by comparison with NCHS data, to describe the risk for intimate partner homicide by demographic variables from 1981 through 1998. Homicide Reporting Supplemental homicide reporting began in the 1960s. The data collection form did not change during 1981–1998. Participating police departments complete the forms for every homicide that occurs within their jurisdictions and submit the forms monthly to the FBI as part of the Uniform Crime Reporting Program.4 All homicides that occur in the United States are included, and these homicides include U.S. and non U.S. residents. Deaths of U.S. residents abroad are not included. Data are not updated to reflect the results of subsequent investigation after they are submitted.5 Throughout this report, homicide rates refer to rates of victims rather than rates of perpetrators. This study excluded negligent homicides; homicides termed justifiable, which is defined by the FBI as the killing of a person committing a felony; and homicides resulting from legal intervention. The reports also include the relation of the victim to the offender if known when the reports are submitted. This study included homicides in which the victim was age 10 or older and the perpetrator was an intimate partner. The relationship categories are classified as intimate partner relationships are spouse, ex-spouse, common-law spouse, boyfriend, girlfriend, and homosexual relationships. There is no separate category for ex-boyfriend or ex-girlfriend, although such persons also are regarded as intimate partners by Centers for Disease Control and Prevention.6 Such persons would probably have been categorized as acquaintances by the FBI and therefore would not have been included in this study. Initial comparison of the total number of homicides in supplemental homicide reports with the total number of homicides not caused by legal intervention7 and reported by NCHS indicated that the database had included 85 to 90 percent of homicides recorded on death certificates from 1981 through 1998. Analyzing the Data From 1981 through 1998, 346,258 homicides were recorded in the supplemental homicide report database, and 381,408 homicides were recorded in the vital records database. Among the homicides, 16,809 were dropped from the analysis because they were classified as negligent manslaughter or justifiable homicide or were associated with legal intervention. An additional 28,927 homicides were dropped from the analysis because they involved multiple victims or because the age, race, or sex of the victim was missing. Consequently, 300,522 homicides were available for analysis. The average weight applied to the intimate partner homicide counts to generate the estimated number of intimate partner homicides was the ratio of vital records homicides (381,408) to 300,522 or 1.28. Of 300,522 records, supplemental homicide reports recorded 35,601 (11.8%) After weighting, an estimated 45,513 (11.9%) intimate partner homicides occurred from 1981 to 1998. Of these 45,513, approximately 28,991 (63.7%) of homicides were perpetrated against females, 93.8 percent of males were victimized by females, and 99.5 percent of females were victimized by males. Overall, male intimate partner homicide rates were 62.2 percent of female rates. Rates among females exceeded rates among males for all races except blacks, where intimate partner homicide rates among males were greater than rates among females. The highest overall and sex-specific rates were reported among blacks, followed by American Indian/Alaska Natives, whites, and Asian or Pacific Islanders, in that order. Ethnicity data were collected only from 1980 to 1987, and were not analyzed for this report. Risk for intimate partner homicide was greater for those 20 to 29 than for those 10 to 19. Intimate partner homicide risk peaked for black females 20 to 29, white females and black males 30 to 39, and white males 40 to 49. For all groups except black females, rates for those 80 or older exceeded those for persons 10 to 19. Rates among blacks exceeded rates among whites for females and males in all age groups. Rates among white females exceeded rates among white males for every age group, whereas rates among black males surpassed rates among black females in the 30–39 age group, and remained greater through successive age groups. Homicide against Children Overall, 113 homicides occurred among children 10 to 14, 0.3 percent of the total. Intimate partner homicides occurred at ages as young as 12 years. A total of 1,845 homicides occurred among those 15 to 19, which is 4.1 percent of the total. The 2,666 homicides among those 65 or older accounted for 5.9 percent of the total. Persons 20 to 64 accounted for approximately 90 percent of intimate partner homicide. From 1981 to 1998, intimate partner homicides decreased by 47.2 percent in the United States. Rates decreased among both whites and blacks. In that period, rates among white females decreased 23 percent, and rates among white males decreased 61.9 percent. Rates among black females decreased 47.6 percent, and rates among black males decreased 76.4 percent. As a result of the greater decrease in rates among black males versus black females, black females as of 1998 had the highest rates among black and white males and females. Overall, rates among males decreased 67.8 percent, and rates among females decreased 30.1 percent. The risks for intimate partner homicide among white and black females varied across states, but were highest in southern states. Rates among males are not indicated by state because of the unstable intimate partner homicide rates for both races. Rates among white females were higher in southern states and Rocky Mountain states. Rates were lowest among white females in New England and the upper Midwest. Among black females, the highest rates were clustered in southern states, but rates were unstable in many western and New England states. The highest rate among white females was in South Carolina; the highest rate among black females was in Arkansas. The risk for intimate partner homicide consistently decreased with decreasing city size for both males and females. Cities with more than 250,000 residents had rates two to three times the rates of cities of fewer than 10,000 residents. However, rural counties indicated rates comparable with those of cities of 50,000 to 99,999 residents. Approximately 50 percent of all intimate partner homicide victims of either sex were killed by their legal spouses. Approximately 33 percent were killed by boyfriends or girlfriends. The proportion of intimate partner homicides committed by same-sex partners was much greater for males than females. Among black victims of both sexes and female American Indian/Alaska Natives victims, a greater percentage was killed by boyfriends or girlfriends than by current spouses. Among male American Indian/Alaska Natives victims, an equal percentage was killed by girlfriends as by current spouses. Among white and Asian victims of both sexes, a greater percentage was killed by current spouses than by boyfriends or girlfriends. Firearms were the major weapon type used in intimate partner homicides among both sexes. Males were more likely to be killed by knives than females, while females were more likely to be killed by blunt objects or blows delivered by the hands or feet. Boyfriends and girlfriends and common-law spouses were much less likely to be killed by firearms than spouses and ex-spouses. Male victims killed by girlfriends or common-law spouses were equally likely to be killed by firearms and knives. In the analysis of the distribution of deaths by month, observed numbers exceeded expected numbers (i.e., the observed-to-expected ratio exceeded one) during the summer months among both white and black males. This pattern was less noticeable for females. For all race-sex groups, January, October, and November were below expectations, although the deficit was least noticeable among white females. The difference between the peak and nadir months was greatest among white males, for whom the risk for intimate partner homicide was 30 percent greater in July than in October. Women at Greater Risk From 1981 to 1998, substantial variation occurred in the risk for intimate partner homicide by race, sex, age group, time, state, and community size. Populations identified with the highest estimated rates were the same as those identified in previous studies using the supplemental homicide reports.8 Data from this analysis indicated that females have an overall greater risk for intimate partner homicide victimization than males. This was consistent with studies of sex-specific rates of nonfatal intimate partner assaults from emergency department data.9,10 Surveys that focused on more serious assaults (e.g., those accompanied by injuries) also reported a greater rate of assaults on females11,12 while surveys that included a substantial share of assaults without physical injuries between partners report equal victimization rates.13,14 The general interpretation of the data was that males have a size and strength advantage that reduces their risk for injury in any physical confrontation with a woman.15 Rates among black females decreased 48%, and rates among black males decreased 76% Why intimate partner homicide rates among black males were greater than rates among black females is unclear. Also unclear is why white males were at approximately the same risk as white females for intimate partner homicide in the early 1980s. One possible explanation is that females used lethal weapons more often in altercations with male intimate partners to compensate for their size and strength disadvantage. Intimate partner altercations involving firearms and knives are substantially more likely to result in death than other types of altercations.16 From 1981 to 1998, blacks had the highest intimate partner homicide rates for both sexes. Rates among whites and Asian or Pacific Islanders were lowest, with rates among American Indians/Alaskan Natives in between those among blacks and whites. Higher rates for nonfatal intimate partner altercations have been reported among nonwhites.11,12 One study reported a greater rate of intimate partner homicides among American Indians/Alaskan Natives.17 These rate differences among racial groups could partially or fully be explained by socioeconomic differences. Females with low education and income levels have a greater risk for intimate partner violence.11,18–23 Risk Begins at Puberty The risk for intimate partner homicide begins at puberty, and increases substantially when adolescents reach ages 20 to 29. Younger females have a greater risk for intimate partner violence as well as intimate partner homicide.11,19,20,22,24 This risk could be evident because females tend to move away from the protection of home in their 20s. However, the highest risk for intimate partner homicide, at least for a white female, does not occur until her 30s. Intimate partner homicide risk for black and white females decreases substantially thereafter. For males, the highest risk for intimate partner homicide occurs approximately 10 years after the peak periods for females of the same race and decreases more slowly with age. Previous studies reported that the mean age of male perpetrators of intimate partner homicide is three to four years greater than that of their victims2 and that risk increases with the age difference.24 Rates of nonfatal intimate partner violoence also have decreased.25 The identification of domestic violence as a national problem, subsequent legal and social measures (e.g., legal advocacy services, hotlines, shelters) to remedy domestic violence, as well as rising divorce rates, have led to greater percentages of abused females ending cohabitation with abusers.26,27 These measures might be expected to equally reduce rates among males and females in parallel. However, data indicated that greater decreases occurred in intimate partner homicide rates among males from 1981 to 1998. In 1981, rates among males were only slightly less than rates among females, whereas in 1998, rates among males had decreased to less than half the rates among females. The reason for the more substantial decreases in rates among males compared with females is not known. Firearm-related homicide rates among males might have been reduced by simplifying the process by which females can leave their abusers. Theoretically, a female who does not live with her attacker could be less likely to kill him with his own firearm. In addition, overall rates among females might not have decreased as much as rates among males because of social and legal changes that have brought about an increase in intimate partner homicide rates among females in less formal noncohabiting relationships with males. From 1976 through 1995, the only type of intimate partner homicide to increase was that of white females by their boyfriends, where the rate increased 29 percent.3,28 A comparison of trends in intimate partner homicide with trends in total homicides demonstrates that other nonspecific factors might be involved. The most appropriate comparison is with total homicides among adults because teenage intimate partner homicides account for less than five percent of all intimate partner homicides, whereas teenage homicides account for a majority of the variation in overall homicide rates from 1981 to 1998.8 The comparison documents that intimate partner homicide decreases occurred at the same time as decreases in total homicides. Demographic DataTable: Intimate Partner Homicides 1981-1998From 1981 to 1998, total homicide rates among persons those 20 and older decreased 30.9 percent among females and 43.1 percent among males. Therefore, the decrease in female intimate partner homicide (30.1%) is essentially the same as the decrease in total adult female homicides while the decrease in male intimate partner homicide (67.8%) is more substantial than the corresponding decrease in total adult male homicides. Possibly, the nonspecific demographic, social, and economic changes also contributed to the decrease in IPH among both sexes.29 From 1981 to 1998, intimate partner homicides decreased by 47.2 percent in the United States Comparison of rates by state for white and black females indicates a pattern similar to that of all homicides, with greater rates in the southern and western states when stratified by race.30 This regional variation might be attributable to differences in cultural and social norms. For example, southerners might be more likely to endorse violence in response to insults.31,32 The steady increase in risk for intimate partner homicide with urbanization is consistent with the pattern for homicide8 and nonfatal violence among intimate partners.11,21 However, the relation might be confounded by an association between black race and urban residence.33 An increased risk from residence in rural counties compared with cities has not been reported for all homicides. The distribution of intimate partner homicides by relationship indicates differences by sex and race. However, these differences cannot be interpreted as risk differences without translating them into rates. Such analysis has been conducted previously for whites and blacks3 but not for other races. Previous analysis indicates that intimate partner homicide victimization rates are greater for wives than girlfriends and for husbands than boyfriends. However, these differences have been decreasing perhaps because laws and services addressing intimate partner violence historically have been directed toward married persons.27 The weapon type used also varies by the victim's sex and relationship to the perpetrator. The percentage of male intimate partner homicide victims killed with firearms (59.1%) is less than the percentage of all male homicide victims killed with firearms during the same time period (69.1%). Knives were used to kill 35.1 percent of male intimate partner homicide victims and 16.1 percent of all male homicide victims during the same period. In contrast, the percentage of female victims killed with firearms (64.1%) was greater than the percent of all female homicide victims killed with firearms (47.5%). Knives account for 17.4 percent of all female homicides and 16.1 percent of female intimate partner homicide. Therefore, female victims are more likely to be killed with a gun than are all female homicide victims, whereas male victims are more likely to be killed with a knife than are all male homicide victims. Overall, the figures demonstrate the importance of reducing access to firearms in households affected by intimate partner violence.16,34 Firearms are more likely to be used by spouses than by girlfriends in the killing of male intimate partners. This finding might be a result of the association noted previously between intimate partner homicides among unmarried partners and black race. Firearms are less likely to be present in nonwhite households in the United States.35 Finally, the lower observed-to-expected ratios for intimate partner homicides during January, October, and November have not been reported previously. However, a summer increase and autumn decrease in police dispatches for domestic violence disputes have been described in California.36 This seasonal pattern is distinct from that noted among all homicides, where increased rates are observed in the summer, but the winter is the period of lowest rates.37,38 In Brief Amiodarone Compared with Lidocaine for VF Lidocaine has been the initial antiarrhythmic drug treatment recommended for patients with ventricular fibrillation that is resistant to conversion by defibrillator shocks, and research published in the New England Journal of Medicine (2002;346[12]:884) compared intravenous lidocaine with intravenous amiodarone as an adjunct to defibrillation in victims of out-of-hospital cardiac arrest. Patients were enrolled if they had out-of-hospital ventricular fibrillation resistant to three shocks, intravenous epinephrine, and a further shock; or if they had recurrent ventricular fibrillation after initially successful defibrillation. They were randomly assigned in a double-blind manner to receive intravenous amiodarone plus lidocaine placebo or intravenous lidocaine plus amiodarone placebo. The primary end-point was the proportion of patients who survived to be admitted to the hospital. In total, 347 patients (mean [±SD] age, 67±14 years) were enrolled. The mean interval between the time at which paramedics were dispatched to the scene of the cardiac arrest and the time of their arrival was 7±3 minutes, and the mean interval from dispatch to drug administration was 25±8 minutes. After treatment with amiodarone, 22.8 percent of 180 patients survived to hospital admission, as compared with 12 percent of 167 patients treated with lidocaine (P=0.009; odds ratio, 2.17; 95 percent confidence interval, 1.21 to 3.83). Among patients for whom the time from dispatch to the administration of the drug was equal to or less than the median time (24 minutes), 27.7 percent of those given amiodarone and 15.3 percent of those given lidocaine survived to hospital admission (P=0.05). As compared with lidocaine, amiodarone leads to substantially higher rates of survival to hospital admission in patients with shock-resistant out-of-hospital ventricular fibrillation. AAEM Elects New Members The American Academy of Emergency Medicine elected new officers and members of its board of directors at its Eighth Annual Scientific Assembly in March. The new officers who will serve until 2004 are Joseph P. Wood, MD, of Scottsdale, AZ, president; A. Antoine Kazzi, MD, of Orange, CA, vice president; and Tom Scaletta, MD, of La Grange, IL, as secretary-treasurer. Kevin J. Rodgers, MD, was elected to serve as an board member-at-large while Howard Blumstein, MD, and Raymond Roberge, MD, were re-elected to second terms on the board. All three will serve until 2005. Anthony DeMond, MD, James Li, MD, and Paul Sierzenski, MD, were appointed to one-year terms on the board to fill vacancies left by Drs. Kazzi and Scaletta and Margaret O'Leary, MD." @default.
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• W2327777488 title "Noting Lower Rate of Intimate Partner Homicides, Experts Point to Remedies that Appear to Work" @default.
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