Pattern of intentional drowning mortality: a total population retrospective cohort study in Australia, 2006–2014

Abstract

Background While a downward trend in unintentional drowning deaths in Australia has been observed, little is known about intentional drowning mortality. Limited information on intentional drowning death impedes the planning, implementation, and evaluation of prevention strategies. This study aims to describe rates of intentional fatal drowning in Australia and compare these to other categories of drowning. Methods Data were sourced from the Australian Bureau of Statistics (ABS) over a 9-year period (2006–2014). Rates and trends of intentional drowning were compared with unintentional, water-transport related and undetermined intent drowning. Rates of intentional drowning deaths across gender, age groups, states/territories, remoteness of residence and First Peoples of Australia were calculated. Relative risk (RR) (95% confidence interval [CI]) was calculated, and chi-square tests of independence were performed ( p < 0.05). Results The crude mortality rate for intentional drowning deaths in Australia over the study period was 0.23/100000, lower than unintentional drowning (0.89/100000). Males were 1.6 (CI: 1.4–2.0) times more likely than females to intentionally drown, however females made up a significantly larger proportion of intentional drowning deaths (38.2%) compared to unintentional deaths (22.4%) (χ 2 = 47.3; df = 1; p < 0.05). A significant linear association between age group and intentional drowning was observed (χ 2 = 131.3; p < 0.05), with individuals aged 75 years and over 32.6 times more likely to intentionally drown. Non-Indigenous peoples were 4.1 times more likely to intentionally drown in comparison to First Peoples of Australia. Residents of Inner Regional, Outer Regional, and Major Cities were 4.2 times (CI: 0.6–30.0), 4.1 times (CI: 0.6–29.9), and 4.0 times (CI: 0.6–28.6) more likely to intentionally drown, respectively, compared with residents of Very Remote areas. Conclusions This study adds to the limited evidence currently available about intentional drowning rates and trends in Australia. Being male, of older age groups, non-Indigenous, residing in Inner and Outer Regional areas, and Major Cities were risk factors for intentional drowning deaths. Improving data collection systems and furthering understanding of the risk factors of intentional drowning, as well as the development, implementation, and evaluation of prevention programmes, are required to reduce the risk of intentional drowning death in Australia.

Next steps for drowning prevention in rural and remote Australia: A systematic review of the literature

“…46 Data time periods ranged from 1987 to 30 June 2019, with one study comparing by remoteness in Western Australia (WA) from 1953-1962 to 1983-1992. 37 Studies varied in their use of classification systems for remoteness with 20 studies using standard classification systems, 3,12,[18][19][20][21][22][23][24][25][26][27]30,[38][39][40][41][42][43]46 four studies modifying existing standard classification systems 16,29,44,45 and eight studies using their own classification system (Table S2). 28,31-37…”

“…Twenty-one studies (65.6%) reported epidemiological data by remoteness. Eighteen studies included fatal data 3,12,16,[18][19][20][22][23][24][25][26][27]29,32,34,37,38,44 while five included non-fatal data. 3,16,20,27,44 Three studies included grouped data on both fatal and nonfatal drowning.…”

Vulnerability to fatal drowning among the population in Southern Bangladesh: findings from a cross-sectional household survey

“…In addition to unintentional external cause of drowning codes, watercraft and flood-related drowning, and intentional self-harm by drowning codes were also included. Studies have suggested to include these later codes (drowning from watercraft, flood related and intentional self-harm) to obtain more representative magnitude of fatal drowning 28 29. Intentional drownings particularly suicides are culturally stigmatised in Bangladesh.…”

Epidemiology, Risk Factors and Measures for Preventing Drowning in Africa: A Systematic Review

“…Furthermore, future research should focus on the intent for drowning in Africa, which would help to inform policies and prevention interventions. A recent article on intentional drowning reported an increasing rate of intentional drowning and proposed a multidisciplinary collaboration public health and other services including mental health, education and drowning prevention organisations to prevent intentional drowning [71].…”