Article Text

Download PDFPDF
Linking out-of-hospital deaths with a regional hospital-based firearm injury database: a clinical researcher’s guide to accessing data from the National Death Index
  1. Kristen Mueller1,
  2. Benjamin P Cooper2,
  3. Vicki Moran3,
  4. Michael Mancini4,
  5. Randi E Foraker2
  1. 1Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  2. 2Institute for Public Health, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  3. 3Trudy Busch Valentine School of Nursing, Saint Louis University, St Louis, Missouri, USA
  4. 4Saint Louis University School of Social Work, St Louis, Missouri, USA
  1. Correspondence to Dr Kristen Mueller, Emergency Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA; kristen.mueller{at}


Introduction Firearm injuries are a public health crisis in the US. The National Death Index (NDI) is a well-established, comprehensive database managed by the National Center for Health Statistics at the CDC. In this methodology paper we describe our experience accessing and linking data from the NDI to our regional, hospital-based violent injury database to identify out-of-hospital deaths from firearms.

Methods We outline the key steps of our submission to the NDI. Data were collected from research team meeting notes, team member emails with NDI staff, and information provided from the NDI website and supplementary guides. Few of our collaborators or university partner investigators had accessed or used data from the NDI. We discuss the online NDI Processing Portal data request, data preparation and receipt from the NDI, troubleshooting tips, and a timeline of events.

Results Our query to the NDI returned 12 034 records of 12 219 firearm-injured patient records from 2010 and 2019. The record match rate was 98.5%.

Discussion Linking hospital-based data sets with NDI data can provide valuable information on out-of-hospital deaths. This has the potential to improve the quality of longitudinal morbidity and mortality calculations in hospital-based patient cohorts. We encountered logistic and administrative challenges in completing the online NDI Processing Portal and in preparing and receiving data from the NDI. It is our hope that the lessons learnt presented herein will help facilitate easy and streamlined acquisition of valuable NDI data for other clinical researchers.

What this study adds:

- A step-by-step guide for clinical researchers of how to apply to access data from the National Death Index (NDI).

- Advice and lessons learned on how to efficiently and effectively access data from the NDI.

- A well-described methodology to improve the quality of longitudinal morbdity and mortality calculations in hospital-based cohorts of firearm injured patients.

What is already known on this subject:

- There is a need for robust, longitudinal data sources that reliably track morbidity and mortality among firearm injured patients in the United States.

- The NDI is a well-established, comprehensive database that holds death records for all 50 states, which provides valuable mortality data to the public health and medical research community.

  • public health
  • firearm
  • process/impact evaluation
  • recidivism
  • epidemiology

Statistics from


  • Twitter @KMueller_MD

  • Contributors All authors contributed to study concept and design and critical revision of the manuscript for important intellectual content. KM and BPC completed the acquisition of data, analysis and interpretation of data, and drafting of the manuscript. KM, the guarantor for this work, accepted full responsibility for the overall content of this work, had access to the data, and controlled the decision to publish.

  • Funding KM is supported in part by the Emergency Medicine Foundation and the American Foundation for Firearm Injury Reduction in Medicine at Aspen Institute.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.