METHODS: Counts of Massachusetts resident deaths, hospital stays, and emergency department visits associated with injuries due to legal intervention were generated for the ten year period 2004-2013 utilizing statewide death, inpatient hospital, observation stay and emergency department discharge databases. Trends, average annual rates and sub-analyses by sex, age subgroup, race/ethnicity and mechanism of injury, were examined. Injury cases were defined using methodology similar to the state injury indicators. To identify cases due to legal intervention, ICD-10 codes Y35.0-Y35.7 and Y89.0 were used for the death database; ICD-9-CM codes E970-E977 were used for the hospital and emergency department databases. Legal execution codes were excluded.
RESULTS: For the ten year period 2003 through 2014, 45 Massachusetts residents died due to legal intervention, an average annual rate of 0.1 per 100,000 residents. Ninety-five percent of the deaths were male (n=43) and 95% were caused by firearms (n=43). Death rates among black, non-Hispanics were more than eight times that of white, non-Hispanics and four times that of Hispanics. There were 379 hospital stays and 6,198 emergency department discharges during this period for these injuries (average annual rate 0.6 and 9.5 per 100,000 persons, respectively). Residents ages 15-24 years, and males had the highest rate of hospital stays and emergency department visits, compared with their demographic counterparts. Black non-Hispanics and Hispanics had average annual hospital stay rates four and three times that of White, non-Hispanics, respectively, with similar disparities seen for emergency department visits. Most hospital stays and emergency department visits (51.5% and 88.7%) were coded to E975 “other specified means” which includes manhandling and blows, while 19% and 1.5% of these cases, respectively, were coded to firearms.
CONCLUSIONS: This analysis of fatal and hospital-treated legal intervention injuries in Massachusetts highlights the value of using traditional public health databases for the purposes of examining the scope of the problem, existing disparities, and points for potential interventions. While legal intervention fatalities are relatively uncommon in Massachusetts, for each death during the ten year period, there were 8 hospital stays and 137 emergency department visits. Significant racial/ethnic, gender and age disparities exist.