Variation in toxicology testing for violent deaths and suicides by geography and medicolegal death investigation system type - National Violent Death Reporting System, 2023.

Abstract

Although toxicology testing is critical for identifying substance involvement in violent deaths and suicides, testing is not standardized and varies across states and medicolegal death investigation (MDI) systems in the United States. This study examined geographic and system-level variation in toxicology testing among violent deaths and suicides. Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS) data from 2023 was analyzed. Decedents were classified as having toxicology testing if any substance was indicated as tested. Percentages of decedents with toxicology testing overall and by manner of death, state, and MDI system type were calculated. Toxicology testing varied across geography and MDI system type. State-level overall testing rates varied widely, ranging from a low of 15.1% to a high of 99.0%. Centralized systems consistently reported the highest percentage of toxicology testing across all manners of death (overall: 79.5%; homicide: 88.7%; legal intervention deaths: 91.5%; suicide: 72.2%; undetermined intent: 94.9%; unintentional firearm injury: 85.1%). Local mixed systems generally exhibited the lowest frequency of testing (overall: 48.1%; homicide: 52.4%; legal intervention: 67.7%; suicide: 44.9%; undetermined intent: 58.4%; unintentional firearm injury: 41.7%). Toxicology testing rates for violent deaths and suicides varied substantially by state/jurisdiction and MDI system. These findings highlight opportunities to standardize testing protocols and address gaps in lower-testing states/jurisdictions, which could strengthen violent death and suicide surveillance, enhance the accuracy and completeness of substance-related data, and support prevention efforts at state and national levels.