Death Studies, 28: 6597669, 2004

Copyright # Taylor & Francis Inc.

ISSN: 0748-1187 print / 1091-7683 online
DOI: 10.1080/07481180490476515

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A COMPARISON OF THREE SOURCES OF DATA

ON CHILD HOMICIDE
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JACQUELYN M. LYMAN, GERALD MCGWIN, Jr., GREGORY DAVIS,

TOMISLAV V. KOVANDZIC, WILLIAM KING AND STEN H.VERMUND
University of Alabama at Birmingham, Alabama, USA

This study compared data from death certificates (DC), medical examiner (ME)
reports, and Uniform Crime Reporting (UCR) Program for homicides among children
age 5 years or younger inJefferson County, Alabama between 1988 and 1998. Records
from each source were matched independently to records from the other two sources. Kappa
coefficients measured the chance-corrected agreement between sources.The strongest correlations were for victims gender and race. Correlations were weakest for victims relationship to the offender and offenders gender. DC and ME data demonstrated excellent
agreement and provided a comprehensive count of homicides inJefferson County, whereas
UCR comparisons had lower correlations. However, the UCR is a valuable source of child
homicide data in the United States that is underutilized in public health research.

The United States has the highest rates of childhood homicide, suicide, and firearm-related deaths among industrialized countries (Centers for Disease Control and Prevention, 1997). During the 1980s,
homicide surpassed motor vehicle crashes as the leading cause of infant
injury death (Hicks & Gaughan, 1995), accounting for almost one third
of such fatalities in the United States by 1996 (Ventura, Peters, Martin,
& Maurer, 1997). In 1998, homicide was the 12th leading cause of death
among infants and the 4th leading cause among children aged 1 to 5
years (Centers for Disease Control and Prevention, 2001; National Center for Health Statistics, 2000).
Received 13 August 2003; accepted 1 November 2003.
Address correspondence to Gerald McGwin, Jr., 120 Kracke Building, 1922 7th Avenue
South, Birmingham, AL 35294-0016. E-mail: Gerald.McGwin@ccc.uab.edu

659

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J. M. Lyman et al.

Various data sources have been used to study trends in homicide

among young children. Many studies have used vital records to examine
risk factors for infant homicide (Overpeck, Brenner, Trumble, Trifiletti,
& Berendes, 1998; Siegel et al., 1996; Cummings, Theis, Mueller, &
Rivara, 1994). Other studies have used medical examiner/coroner
records to provide a profile or picture of this important problem (Collins
& Nichols, 1999; Hall, Reyes, Meller, & Stein, 1993). An additional data
source used by only a few studies is the Federal Bureau of Investigations
(FBI) Uniform Crime Reporting (UCR) Program (Jason, Gilliland,
& Tyler, 1983). UCR is a law enforcement program that operates with
city, county, and state officials and provides a nationwide view of crime
based on the submission of statistics by law enforcement agencies (Federal Bureau of Investigation, 1999).
Medical examiner (ME) records are a valuable data source for injury
epidemiology and have been used to study a variety of fatal injuries
including homicides (Herman-Giddens et al., 1999; Conroy & Russell,
1990). An advantage of ME records is that they may contain very
detailed information describing a persons death. Although a death certificate (DC) is limited to short narrative phrases, the ME report will
usually explain, if it is known, how the person was injured and the nature of injuries ultimately resulting in death. ME records are often used
to validate other sources of information (Conroy & Russell, 1990).
To examine the assumption that ME databases contain information
on most injury deaths, Dijkhuis et al. (1994) compared Iowas ME database with DC of persons who died of fatal injuries during 1990 to 1991.
When injury deaths were categorized according to cause, over 80% of
intentional injury deaths (homicides and suicides) had a corresponding
ME report available. The authors concluded that the use of ME reports
is most useful when analyzed in conjunction with vital records.
Rokaw, Mercy, and Smith (1990) compared national homicide data
for 1976 to 1982 from the National Center for Health Statistics and the
UCR Program to determine the usefulness of these two data collection
systems for public health surveillance and research.Variations occurred
in the average ratios of the frequencies of homicides reported by the
two systems across age subgroups. For children younger than age 5
years, the number of homicides reported by the two data sources was
nearly identical with National Center for Health Statistics reporting less
than 1% more cases than the UCR.The current study focused on homicide among young children for this reason.

Comparison of Child Homicide Data

661

The purpose of this study was to describe and compare the type and
consistency of data available from DC, ME reports, and the UCR
Program with respect to child homicide. This has not been done previously. Because of variations in the collection of ME data for large geographic areas (e.g., statewide), this study was limited to a single county
(Jefferson County) in Alabama. The comparison of these sources will
help guide future researchers in their decisions regarding which data
sources to use when studying homicide among young children as well
as for comparing studies using different sources.
Methods
Case Definition and Data Sources
Case definition was specific to the data source. Cases for both DC and
ME sources were included if they were deemed to have been homicides
or deaths that may have been homicides but in which the intent was
undetermined. DC containing International Classification of Disease, 9th
Revision (ICD-9) codes E960 through E969 (homicide and injury purposely inflicted by other persons), E980 through E989 (injury undetermined whether accidentally or purposely inflicted), and 799.9 (other
ill-defined and unknown causes of morbidity and mortality) were
included as cases. UCR cases were exclusively confirmed homicides.
Previous studies have demonstrated that deaths with undetermined
intent have characteristics similar to homicides (Overpeck et al., 1999;
Sorenson, Shen, & Kraus, 1997). Therefore, inclusion of these cases in
this study is consistent with the methods of other studies of homicide
and traumatic injury in children (Vanamo, Kauppi, Karkola,
Merikanto, & R
s
nen, 2001; Overpeck et al., 1998; Siegel et al., 1996;
Cummings et al., 1994).
For purposes of this study, DC and ME data were limited to residents
of Jefferson County, Alabama aged 5 years or younger. UCR data were
limited to events occurring inJefferson County in this age group. A birth
cohort approach was used with all three sources so that the deaths were
only those of subjects born in the years 1988 through 1998 and did not
include deaths occurring in children born in previous years.
UCR Program data are provided monthly to the FBI by local law
enforcement agencies participating in the program. Participation in the
national UCR Program is voluntary. Law enforcement agencies that

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J. M. Lyman et al.

report homicides on the basic UCR form are requested, but not
required, to submit a Supplementary Homicide Report. Contributors
to the UCR Program compile and submit their crime data either
directly to the FBI or through their state UCR Programs. State UCR
Programs frequently impose mandatory reporting requirements that
have been effective in increasing both the number of reporting agencies
and the number and accuracy of each participating agencys reports.
Approximately 83% of the estimated 16,914 homicides that occurred in
1998 were included in the Supplementary Homicide Report (Federal
Bureau of Investigation, 1999).
Matching of Data Sources
Individual records from each data source were matched independently to records from each of the other two sources. Five variables on
the DC and in the ME file were used to match records: date of birth, date
of death, and the decedents gender, race, and age. The month and year
of birth or death, but not the day, were required to match. Agreement
between sources on three of the five variables was considered a match.
For UCR records, the month and year the homicide occurred and the
victims gender, race, and age were used to match individual records to
the other two data sources. The month the incident occurred and victims age were allowed to vary by one unit. Agreement between sources
on three of the five variables was considered a match.
Analysis
Kappa coefficients were used to measure the chance-corrected agreement in the categorical classification of information for each variable
analyzed using the computer program PEPI.The strength of agreement
by kappa coefficient was evaluated as recommended by Altman: <0.20
indicates poor agreement, 0.2170.40 indicates fair agreement,
0.4170.60 indicates moderate agreement, 0.6170.80 indicates good
agreement, and 0.8171.0 indicates very good agreement (Altman,
1991). Standard error-based 95% confidence intervals were also calculated.
Three comparisons were made: DC and ME, DC and UCR, and
ME and UCR. Variables that were consistently present in at least two
of the three data sources were analyzed. Demographic data of the victim
(i.e., gender, race, and age) were compared among all three sources.

Comparison of Child Homicide Data

663

Manner of death (homicide or intent undetermined) was compared

only for DC and ME data sources. For the DC source, manner of death
was based on the ICD-9 code listed as cause of death. For homicides,
the victims relationship to the offender and the offenders gender were
compared for the UCR and ME data sources.
Kappa coefficients were based on comparisons of matched records
containing known values for the variable analyzed. In other words, if
the value of a variable was unknown for one of the sources, then the
matched record was not included in the calculation of the kappa coefficient. This approach is conservative and results in abest case scenario
when evaluating the agreement among these sources. For this reason,
kappa coefficients were recalculated in order to include cases where
there was an unknown value and thus provide a worst case scenario.
In such instances, the matched record was considered to be in
disagreement.

Results
Birmingham, the largest city in Alabama, is located inJefferson County,
which is the most populous county in the State. In 1990, the total population was 651,525 with approximately 64% of the population White
and 35% Black. Among children younger than age 6, 56% were White
and 43% were Black.
Fifty-seven DC records, 52 ME cases, and 20 cases from the UCR
program met inclusion criteria. Of the 57 DC records, 77% were
matched to ME records, and 63% were matched to UCR records. Of
the 52 ME records, 98% were matched to a DC, and 59% were
matched to a UCR record. Eighty percent of the 20 UCR records were
matched to a DC or an ME record. Table 1 summarizes the calculated
kappa coefficients and corresponding 95% confidence intervals for the
variables analyzed, as well as the number of matched records used for
each calculation. Discrepancies in the number of matched records
between sources are explained in the Discussion section.
Overall, the variables with the strongest kappa coefficients for each of
the three comparisons were the victims gender and race. For the variable gender, there was perfect agreement among the 51 matched DC
and ME records. Kappa coefficients for records matched between DC
and UCR (k 0.86) and ME and UCR (k 0.88) were also very high,

664

Note. CI, confidence interval.

Worst case scenario

Total matched records
Victims race
Offenders gender

Best case scenario

Total matched records
Victim
Gender
Race
Age
Relationship to offender
Offenders gender
Manner of death

Variable

51
51

16
15

15
13
15

51
50
51

51

16

DC-UCR

51

DC-ME

16
16
14

16
15
16
10
9

16

ME-UCR

Number of matched records

0.87 (0.73, 1.0)

0.82 (0.69, 0.96)

1.0
0.91 (0.78, 1.0)
0.93 (0.85, 1.0)

DC-ME

0.72 (0.38, 1.0)

0.86 (0.61, 1.0)

1.0
0.49 (0.15, 0.83)

DC-UCR

ME-UCR

0.72 (0.38, 1.0)

0.18 (
0.05, 0.42)

0.88 (0.64, 1.0)

0.84 (0.55, 1.0)
0.60 (0.27, 0.94)
0.46 (0.09, 0.83)
0.37 (
0.08, 0.82)

Kappa statistic (95% CI)

TABLE 1 Number of Matched Records for Death Certificate (DC), Medical Examiner (ME), and Uniform Crime Reporting (UCR)
Data Sources and Kappa Statistic for EachVariable Analyzed for Bestand Worst Case Scenarios

Comparison of Child Homicide Data

665

demonstrating very good agreement. The 13 matched DC and UCR

records had perfect agreement for victims race. The kappa coefficients
for race were also high for matched DC and ME records (k 0.91) and
matched ME and UCR records (k 0.84). The kappa coefficient for
age was high for the matched DC and ME records (k 0.93) but was
lower for the other paired data source age comparisons.
With respect to the agreement of offender-related variables, which
was only calculated in the ME and UCR comparisons, offender gender
had only fair agreement (k 0.37), and relationship between the offender and victim had moderate agreement (k 0.46). The agreement
between the DC and ME for manner of death was good (k 0.82).
The second part of Table 1 presents the worst case scenario that
includes any cases where an unknown value was present. Although the
kappa values for victims race decreased, the comparisons still demonstrated good to very good agreement. However, agreement onoffenders
gender, which originally was only fair, demonstrated poor agreement
(k 0.18). The relatively small changes in kappa values for victims race
were due to the inclusion of a total of four cases across the three comparison groups, whereas an extra five cases included in the kappa calculation for offenders gender resulted in a larger change.
Discussion
This is one of the first studies to compare the reporting and consistency
of individual data items from three different sources of homicide data.
For some key variables (victims gender and race), considerable agreement was found between DC, ME, and UCR data regarding early
childhood homicide, but other variables (victims age, crime-related
data) demonstrated less consistency.
The DC records contained 24 homicides and 33 deaths where intent
was undetermined. The DC for 12 undetermined deaths and one homicide could not be matched to an ME record. All 12 of the unmatched
undetermined deaths had the ICD-9 code 799.9 (other ill-defined and
unknown causes of morbidity and mortality) reported as cause of death
on the DC. The most likely explanation for these unmatched records is
that the death was not classified as undetermined by the ME and
therefore would not be among the pool of ME files. The ME files contained 27 homicides and 25 deaths with undetermined intent. Of these,
four undetermined deaths and four homicides could not be matched to

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J. M. Lyman et al.

a DC. A likely explanation for this is that the ICD-9 code listed on the
DC was not one of the codes used to define undetermined deaths in the
current study. Another possible explanation for this is that the death
occurred in Jefferson County, with the autopsy performed by the
Jefferson County Coroner/Medical Examiner Office (JCCMEO), but
the victim was a resident of another county. In such a scenario, a
JCCMEO file would exist, but there would be no matching record in
the pool of Jefferson County resident DC. This situation is also a likely
reason why several UCR records could not be matched to a corresponding DC and/or ME record. Although the UCR reports where the homicide occurred, it does not list the residency of the victim.
Eight of the 12 agreement comparisons made in this analysis were in
the very good to perfect agreement range (k 0.82 to 1.0). Two of the
four that did not fall into the very good to perfect range were comparisons of the age of the victim. The one age comparison in very good
agreement compared the victims age according to the DC and the ME
record. The comparisons with lower agreement compared these sources
to the UCR. UCR records victim age in years, whereas the DC and
ME provide a more detailed age (e.g., days, weeks, or months if less than
one year). Rounding of the victims age may be a possible reason for the
lower kappa values when making comparisons to the UCR.
The other two comparisons that did not fall into the very good to perfect range involved offender characteristics (offender gender and relationship to the victim). For these variables, the ME records were
compared with UCR records. It is important to point out that the collection of information on the offender is not a primary objective of ME
investigations and generally includes only what is known at the time of
autopsy and shortly thereafter. Therefore, ME files may not have had
the most current information with respect to offender characteristics.
All four of the comparisons that did not fall into the very good to perfect agreement range involved the UCR. The UCR Program also contributed eight of the nine comparisons with unknown values included
in the worst case scenario analysis. There are several limitations of the
UCR Program, including the voluntary reporting nature of the program. Even if the law requires participation by local agencies, the state
reporting agency may not actively enforce this requirement. Reporting
may also be viewed as a bookkeeping activity and therefore not be considered a priority for busy law enforcement agencies (Rokaw et al.,
1990). Data entry personnel are likely to be inadequately trained for this

Comparison of Child Homicide Data

667

same reason. The political atmosphere of a community or county may

also have an effect by actually discouraging complete reporting of homicides in an effort to demonstrate improvements in public safety. These
limitations may explain, in part, the lower number of homicides
reported by this source and why some UCR variable comparisons did
not have high agreement.
The current study was limited by the use of a single county in
Alabama. Although Jefferson County represents the largest metropolitan area in Alabama, it is one of 67 counties in the state. Because of the
urban and suburban nature of Jefferson County, the results of this investigation may not be applicable to other parts of Alabama. However, this
is the first study to examine the availability of different data elements
from the DC, ME, and UCR data sources and to evaluate the comparability of these data.
In summary, the DC and ME data sources were consistently in very
good to perfect agreement. Although only half of the comparisons using
either of these two data sources with the UCR Program data reached
the same high level of agreement, the remaining four comparisons
achieved fair or moderate agreement. However, the UCR Supplementary Homicide Reports provide the most reliable and timely data on
the extent and nature of homicides in the United States. Researchers
who desire the inclusion of crime-related data in their studies will find
the UCR Program the most useful.
Conclusion
DC and ME records provided the most comprehensive count of child
homicides inJefferson County. The high level of agreement between the
two sources suggests they can be used interchangeably, depending on
the goals and scope of a study. Although underreporting of homicide in
young children by the UCR Program occurred in this study of Jefferson
County, Alabama, this is not necessarily the case in other parts of the
country. Researchers can compare the number of homicides reported
by the UCR to the number that occurred according to DC data to get
an indication of the level of UCR reporting in the geographic region of
interest. The good to very good agreement demonstrated between the
UCR and both the DC and ME data in this study indicates the UCR is
a valuable source of child homicide data that is underutilized in public
health research.

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J. M. Lyman et al.

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