Deaths caused by law enforcement and reported in US death-certificate data increased from 2003 to 2024 among adults and children, with non-Hispanic Black males having the highest mortality rates in every year examined.
The researchers conducted a serial cross-sectional analysis of National Center for Health Statistics (NCHS) Multiple Cause-of-Death records from 2003 to 2024. Deaths were included when legal intervention was recorded as an underlying or contributing cause, excluding legal executions. They calculated population-based crude mortality rates per 100,000 person-years and examined results by age, sex, and race and ethnicity. Children were defined as those younger than 18 years.
Overall, death certificates identified 11,775 deaths caused by law enforcement, including 11,505 adults and 270 children. Among adults, annual deaths increased from 363 in 2003 to 809 in 2024, while mortality increased from 0.17 to 0.31 per 100,000 person-years, corresponding to an estimated annual increase of 3.5%. Among children, annual deaths increased from 8 to 37, while mortality increased from 0.01 to 0.05 per 100,000 person-years, corresponding to an estimated annual increase of 5.6%. Firearms accounted for 10,314 deaths, or 88% of the total.
The increase among adults varied over time. Mortality increased by an estimated 2.5% annually prior to 2015, accelerated to 6.5% annually from 2015 to 2020, and increased by 1.8% annually following 2020, with changes in slope.
Among children, mortality was stable prior to 2015 and subsequently increased, with estimated annual increases of 12.2% from 2015 to 2020 and 17.3% following 2020. However, changes in slope at the 2015 and 2020 break points were not statistically significant.
Researchers prespecified break points at 2015 and 2020 based on hypothesized shifts in national attention to police use of force following the deaths of Michael Brown in 2014, Freddie Gray in 2015, and George Floyd in 2020. The segmented models assessed whether the trajectory changed at those points.
Males accounted for 11,204 deaths, or 95% of the total. Non-Hispanic Black males had the highest mortality rate in every year examined, with an overall rate of 0.65 per 100,000 person-years. The disparity was also present during adolescence, with a mortality rate of 0.31 per 100,000 person-years among males aged 13 to 17 years.
Across all demographic groups examined, the highest mortality rate occurred among Black males aged 18 to 29 years, at 1.45 per 100,000 person-years. Researchers reported that non-Hispanic Black and Hispanic populations had higher risks of death caused by law enforcement than White populations, with disparities increasing over time.
The study includes limitations. Deaths caused by law enforcement are underreported in vital statistics, with prior research estimating underreporting as high as 55% because of misclassification and incomplete reporting. The researchers cautioned that rates derived from death-certificate data should therefore be considered underestimates.
Death-certificate coding also may have varied over time because media attention could influence documentation of police involvement. Consequently, the observed increases around 2015 and 2020 could reflect true increases in deaths, improvements in reporting, or both. The researchers noted that Mapping Police Violence reports higher annual counts, although increases through 2024 appear similar.
“These findings highlight the need for more accurate mortality surveillance and for interventions to reduce deaths caused by law enforcement, particularly efforts to prevent firearm deaths,” wrote lead study author Caroline Raymond-King, MD, PhD of the Department of Emergency Medicine at Yale School of Medicine, and colleagues.
Dr. Melnick reported receiving grants from the National Institute on Drug Abuse, the Agency for Healthcare Research & Quality, and the American Medical Association, as well as holding stock options for advisory work with Iolite Health outside the submitted study. No other disclosures were reported.
Source: JAMA