Mortality Classification for Deaths that Follow the Use of Non-Firearm Force by Police: A National Cross-Sectional Study (United States, 2012-2021)

Background Mortality classification for deaths in US police custody has important consequences for epidemiologic monitoring and legal outcomes. Prior literature suggests in-custody death classification is inconsistent and may not reflect non-firearm force that preceded death.

We analyzed the Associated Press “Lethal Restraint” national dataset (United States, 2012-2021; N = 1,036), which included deaths following police use of non-firearm force. Our primary outcomes included whether the death investigator: (1) classified manner of death as a homicide, (2) mentioned a force-related injury/condition in the cause-of-death statement, and (3) mentioned any force. Inverse-probability-weighted logistic models estimated the association of these outcomes with death-investigator jurisdiction type, local political composition (quartile of Republican Party vote %), decedent race/ethnicity, and each agency’s prior classifications. Findings We removed 96 deaths based on exclusion criteria. Of the remaining 940 deaths, 28.5% were classified as homicide, 16.5% had cause-of-death statements mentioning a force-related injury/condition, and 42.6% mentioned any force. In contrast, 73.9% of statements mentioned drugs. Unadjusted results showed homicide classification increased from 25.0% in 2012-2014 to 32.2% in 2018-2021. Models estimating adjusted prevalence differences (aPD) showed that, compared to medical examiner jurisdictions, coroners (aPD: -0.19; 95% CI: -0.31, - 0.06) and sheriff-coroners (a PD: -0.17; 95% CI: -0.28, -0.05) were less likely to classify deaths as homicides. Model results also showed that classifications for incidents occurring in the least-Republican counties were most likely to reflect force across all three manner and cause outcomes. Interpretation Non-homicide classifications and cause-of-death statements making no mention of force were widespread for US in-custody deaths. We identified novel evidence suggesting coroner and sheriff-coroner jurisdictions were especially unlikely to categorize in-custody deaths as homicides, and that incidents occurring in highly Republican counties were least likely to reflect force in the cause or manner of death. Funding Blue Meridian Partners Justice and Mobility Fund Competing Interest Statement The authors have declared no competing interest. Funding Statement This study received funding from the Blue Meridian Partners Justice and Mobility Fund. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and was final responsible for the decision to submit it for publication. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The data were openly available before the study at https://apnews.com/projects/investigation-police-use-of-force. There are no data on living individuals. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data that are the basis for this study are available from https://apnews.com/projects/investigation-police-use-of-force. All data produced in the present study are available upon reasonable request to the authors https://apnews.com/projects/investigation-police-use-of-force