Vanishing racial disparities in drowning in Florida

Burden of fatal drowning in California, 2005-2019

OBJECTIVE

To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research.

METHODS

This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water).

RESULTS

California's fatal drowning rate was 1.48 per 100 000 population (n=9237). Highest total fatal drowning rates occurred in the lower population density northern regions, among older adults (75-84 years: 2.54 per 100 000 population; 85+: 3.47 per 100 000 population) and non-Hispanic American Indian or Alaska Native persons (2.84 per 100 000 population). Male drowning deaths occurred at 2.7 times the rate of females; drowning deaths occurred mainly in swimming pools (27%), rivers/canals (22.4%) and coastal waters (20.2%). The intentional fatal drowning rate increased 89% during the study period.

CONCLUSIONS

California's overall fatal drowning rate was similar to the rest of the USA but differed among subpopulations. These divergences from national data, along with regional differences in drowning population and context-related characteristics, underscore the need for state and regional level analyses to inform drowning prevention policy, programmes and research.

Recent trends in fatal unintentional drowning rates in the United States, 1999-2020

BACKGROUND

This study aimed to examine the trends in fatal unintentional drowning rates among persons aged ≤ 29 years by sex, age, race/ethnicity, and the U.S. census region from 1999 through 2020.

METHODS

Data were abstracted from the Centers for Disease Control and Prevention's WONDER database. International Classification of Diseases Codes, 10th Revision; V90, V92, W65-W74 were used to identify persons aged ≤ 29 years who died of unintentional drowning. Age adjusted mortality rates (AAMR) were extracted by age, sex, race/ethnicity, and U.S. census region. Five-year simple moving averages were used to assess trends overall, and Joinpoint regression models were fitted to estimate average annual percentage changes (AAPC) and annual percentage changes (APC) in AAMR during the study period. 95 % confidence intervals were derived using Monte Carlo Permutation.

RESULTS

Between 1999 and 2020, a total of 35,904 persons aged ≤ 29 years died of unintentional drowning in the United States. Mortality rates were highest among males (age adjusted mortality rate (AAMR) = 2.0 per 100,000; 95 % CI: 2.0-2.0), American Indians/Alaska Natives (AAMR = 2.5; 95 % CI: 2.3-2.7), decedents aged 1-4 years (AAMR = 2.8; 95 % CI: 2.7-2.8), and decedents from the Southern U.S. census region (AAMR = 1.7; 95 % CI: 1.6-1.7). Unintentional drowning deaths, overall, have stabilized from 2014 to 2020 (APC = 0.6; 95 % CI: -1.6, 2.8). Recent trends have either declined or stabilized by age, sex, race/ethnicity, and U.S. census region.

CONCLUSIONS

Unintentional fatal drowning rates have improved in recent years. The results reinforce the need for continued research efforts and improved policies for sustained reduction in trends.

Identifying a gap in drowning prevention: high-risk populations

INTRODUCTION

Some populations have been less susceptible to reductions in drowning than others. It has been hypothesised that this is due to prevention strategies failing to account for the influence of social determinants (such as ethnicity, socioeconomic status). Populations such as ethnic minorities have been over-represented in injury statistics, however this is not well explored in drowning. This study aims to identify high-risk populations for drowning, risk factors and prevention strategies.

METHODS

A literature review undertaken systematically using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was conducted of peer-reviewed literature in English, published between 1990 and 2018 from high-income countries. Search terms included drowning, water safety, ethnic minority, migrant, and culturally diverse.

RESULTS

In total, 35 articles were included. High-risk populations identified were: ethnic minorities, First Nations/Aboriginal people, migrants and rural residents. Over half (51%) focused on children (0-18 years). Risk factors included social determinants, swimming ability and knowledge, attitudes and behaviour. Four intervention studies were found; two focused on upskilling adults from high-risk populations to increase employment opportunities within the aquatic industry; an evaluation of a 10-year rock fishing safety education project and a learn-to-swim programme for minority children. Proposed prevention strategies included education, practical skills, research, policy and engagement.

DISCUSSION

Limited literature exists pertaining to drowning among adults from high-risk populations. There is a need to increase the sophistication of drowning prevention strategies addressing the disparities in drowning from a culturally appropriate perspective. Acknowledging the role of the social determinants of health in drowning prevention is essential in order to improve drowning outcomes for high-risk populations globally.