Data bias and gaps in the standardized measurement of family violence homicide and its injuries in Victoria

Background Family violence homicide (FVH) is a complex and compelling public health issue in Australia and globally, warranting both epidemiological and forensic approaches for accurate injury representation. Comprehensive descriptions of population-wide FVH injuries, especially orofacial injuries, and contextual patterns are lacking. Orofacial injuries are significant because no mandate exists in Victoria, or many other jurisdictions, for dental professionals to report FV injuries.
Objective To determine patterns of orofacial injuries in FVH in the Victorian population including risk factors, and epidemiologic trends.
Methods Five empirical studies were conducted using mixed methods design: (1) a pilot study to standardize the protocol for systematic data gathering from narrative medicolegal reports and imaging; case selection criteria; and injury analysis; (2) Two population studies to investigate frequencies, patterns and typologies of abusive orofacial injuries in adult and child FVH using CT scans and advanced statistics; (3) Joinpoints regression analysis to investigate FVH rate trends by sex, victim/offender relationships, with comparison across three homicide databases to ascertain database reliability; and (4) a descriptive analysis of the representativeness of ICD10 codes for medical and underlying cause of death.

Results Child and adult FVH population studies indicated high frequencies of orofacial injury cases: 90% and 78.1%, respectively. Key differences between child and adult orofacial injury groups were mechanism of injury and orofacial injury types. Risk factors associated with orofacial injuries included: injury mechanism, non-orofacial injury number, alcohol/drug-presence, and offender relationship. An indicative upward trend in FVH rates was observed. Joinpoints analysis showed the National Coronial Information System an unreliable source of trend data for FVH due to lag times. ICD10 codes represented injury mechanism in 76% of cases; medical cause of death 36%.
Conclusions The study describes the state-wide burden of orofacial injuries in FVH, potentially contributing to refining existing clinical tools in FV screening. It establishes analytical and scalable methods for comprehensive injury measurement and data management using updated forensic, public health, and coding methods. Upward trending FVH rates indicate insufficiency of current FV policy, practice, and research for FVH prevention in Victoria. The study unmasked significant data bias in injury representation across leading homicide data systems.