Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia

Abstract

ObjectivesThe epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning.DesignA subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates.SettingAustralia, 1 July 2002 to 30 June 2015.ParticipantsUnintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation.Results2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0–4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65–74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal.ConclusionsThis study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

Causes of distraction leading to supervision lapses in cases of fatal drowning of children 0–4 years in Australia: A 15‐year review

“…Children under 5 are the age group at highest risk of drowning 13,23 and in just 14 cases (3%) a supervision lapse was not a contributory factor. Indoor and outdoor household duties, followed by talking/socialising were found to be the leading distractions from supervision.…”

“…12 This risk extends to non-fatal drowning with an estimated ratio of eight children under five hospitalised for every fatal drowning in Australia. 13 Children under the age of 5 in high-income countries commonly drown in and around the home with private swimming pools posing the highest risk. 9 Pool fencing is an effective strategy for restricting a child's access to water (and therefore their risk of drowning); 14 however, this is often advocated as being a strategy that works best in conjunction with supervision.…”

“…The World Health Organization estimates 66 000 children under the age of 5 drown annually, with the majority of cases in high‐income contexts likely to have been captured in these estimates . This risk extends to non‐fatal drowning with an estimated ratio of eight children under five hospitalised for every fatal drowning in Australia …”

The association between school holidays and unintentional fatal drowning among children and adolescents aged 5–17 years

“…Australia records an average of 19 fatal drownings among children and adolescents aged 5–17 years annually . A further 76 children and adolescents are hospitalised in Australia each year due to non‐fatal drowning . Future research should consider the extension of this study's methodology to the larger cohort of children hospitalised due to a non‐fatal drowning to further examine the impact of school attendance on drowning risk.…”

“…23 A further 76 children and adolescents are hospitalised in Australia each year due to non-fatal drowning. 24 Future research should consider the extension of this study's methodology to the larger cohort of children hospitalised due to a non-fatal drowning to further examine the impact of school attendance on drowning risk. Future research should also explore if the increased risk of drowning during holidays is associated with mortality due to other injuries.…”