The objectives were to identify age patterns in the number of homicide-suicides in the United States by state, the characteristics and frequency distribution of subgroups, and the estimated annual incidence rate for the country and states with the highest counts. A total of 293 cases were ascertained, accounting for 693 deaths, from all 1734 daily newspapers in the United States for the first six months of 2001, and 23 variables were coded. Age-adjusted incidence rates were calculated per 100,000 population. This is the most comprehensive national estimate of homicide-suicides, since there is no national violent death surveillance system. Overall, 21% were committed by older perpetrators, but the percentage varied in 7 states with the highest counts: Florida, California and Texas, Pennsylvania, New York, Virginia, and Ohio. The subtype distribution was similar for old and young: spousal/consortial (75%, 74%), familial (10%, 8%), extrafamilial (10%, 10%), pedicide(5%, 6%), and mass killings (2%, 2%). The estimated United States incidence rate was 0.21 and 0.20 for old and young, but Florida had the highest overall rate (0.41) as well as rates for old and young (0.72, 0.31). This may be because Florida is the fourth most populous state with 25% of the population over 55 and a high suicide rate. Although there are limitations of newspaper surveillance, it suggests hypotheses for further research.
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