Drowning Stats

Please note that this section contains my personal notes from my readings on this topic.

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Drowning is a leading cause of injury-related death in children.

• In 2007, there were 3,443 fatal unintentional drownings in the United States, averaging ten deaths per day. An additional 496 people died, from drowning and other causes, in boating-related incidents.  (Source: “Unintentional Drowning: Fact Sheet” by the Centers for Disease Control and Prevention.)
• More than one in five fatal drowning victims are children 14 and younger.  (Source: “Unintentional Drowning: Fact Sheet” by the Centers for Disease Control and Prevention.)
• For every child who dies from drowning, another four received emergency department care for nonfatal submersion injuries.  (Source: “Unintentional Drowning: Fact Sheet” by the Centers for Disease Control and Prevention.)
• Nonfatal drownings can cause brain damage that may result in long-term disabilities including memory problems, learning disabilities, and permanent loss of basic functioning (e.g., permanent vegetative state).  (Source: “Unintentional Drowning: Fact Sheet” by the Centers for Disease Control and Prevention.)
• In 2006, approximately 1100 US children younger than 20 years died from drowning.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

From 2000 to 2006, drowning was the second leading cause of unintentional injury death among US children between 1 and 19 years of age. ^{(”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)}

• In 2006, unintentional drowning claimed the lives of 1077 US children and adolescents, a fatality rate of 1.32 per 100 000 population.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• Fortunately, drowning deaths of children and adolescents have decreased dramatically since 1985 (2.68 per 100 000) and 1995 (1.96 per 100 000).  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• In 2008, approximately 3800 children younger than 20 years visited a hospital emergency department for a nonfatal drowning event; more than 60% of those children were hospitalized.Most victims of nonfatal drowning do well, but severe long-term neurologic deficits are seen with extended submersion times, prolonged resuscitation efforts, and lack of early bystander-initiated cardiopulmonary resuscitation (CPR). ^{(”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)}
• Overall, 5% to 10% of drowning incidents result in severe neurologic damage, but such poor outcomes are even more common when the drowning occurs in open-water settings. ^{(”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262. Published online May 24, 2010.)}

Who is most at risk?

(Source: “Unintentional Drowning: Fact Sheet” by the Centers for Disease Control and Prevention.)

• MALES: In 2007, males were 3.7 times more likely than females to die from unintentional drownings in the United States.
• CHILDREN: In 2007, of all children 1 to 4 years old who died from an unintentional injury, almost 30% died from drowning.  Although drowning rates have slowly declined, fatal drowning remains the second-leading cause of unintentional injury-related death for children ages 1 to 14 years.
• MINORITIES:
  • Between 2000 and 2007, the fatal unintentional drowning rate for African Americans across all ages was 1.2 times that of whites. For American Indians and Alaskan Natives, this rate was 1.7 times that of whites.
  • Rates of fatal drowning are notably higher among these populations in certain age groups. The fatal drowning rate of African American children ages 5 to 14 is 3.1 times that of white children in the same age range. For American Indian and Alaskan Native children, the fatal drowning rate is 2.2 times higher than for white children.
  • Factors such as the physical environment (e.g., access to swimming pools) and a combination of social and cultural issues (e.g., valuing swimming skills and choosing recreational water-related activities) may contribute to the racial differences in drowning rates. If minorities participate less in water-related activities than whites, their drowning rates (per exposure) may be higher than currently reported.

Sociodemographic Factors
Rates of drowning vary with age, gender, and race.

• The highest rate of drowning is in the 0- to 4-year age group (2.5 per 100,000), and children 12 to 36 months of age are at the highest risk (almost 4 deaths per 100 000).  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• There is a second peak incidence in adolescence, attributable entirely to a high number of male drowning deaths. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• After 1 year of age, males are at greater risk of drowning than are females at all ages. Up to 12 years of age, drowning death is roughly twice as common in boys as in girls, but in adolescents, the rate is approximately 10 times higher for boys. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• The higher drowning rate for males has been explained by greater exposure to aquatic environments, overestimation of swimming ability, higher risk-taking, and greater alcohol use. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Temporal and Geographic Variation
Among all causes of unintentional injury death in the United States, drowning shows the greatest seasonal variation. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

• Among drowning victims younger than 15 years, two-thirds of deaths occur from May through August.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• Drowning also occurs disproportionately on Saturdays and Sundays.
• In a 17-year study (1990–2006) from Maricopa County, Arizona, 43% of the 865 life-threatening pool-related incidents among children 0 to 4 years of age occurred on the weekend.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• The peak time of day was 5:00 to 6:00 PM, and 75% of all incidents occurred between 12:00 and 8:00 PM. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• For the period 2000–2006, the 3 states with the highest number of drowning deaths in the 0- to 19-year age group were California (898), Texas (800), and Florida (798).  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Location

• In a large national study of 1420 drowning deaths in individuals younger than 20 years, 47% occurred in fresh bodies of water (rivers, creeks, lakes, ponds, canals, quarries), 32% occurred in artificial pools, 9% occurred in the home (bathtubs, buckets), and 4% occurred in salt water.  Age is an important determinant of drowning location. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• Most (78%) of the approximately 60 infant drowning deaths that occur each year are in bathtubs and large buckets.  Almost all parents, even those who admitted to other risky behaviors, believe that a child should be at least 6 years old before being allowed to bathe alone.  Unfortunately, many caregivers confess that they do leave young children unsupervised in the bath for some period of time.  The association of unsupervised bathtub drowning deaths with the use of bathtub seats and rings was recognized more than a decade ago.  Three hazard scenarios have been noted: (1) seat tipping over from suction cup failure; (2) child becoming entrapped in leg openings that are too big; and (3) child climbing out of the seat. In response to reports of at least 27 deaths and 29 nonfatal incidents with bath seats from 2003 to 2005, the Consumer Product Safety Commission (CPSC) has released warnings about these products but has not banned them from the market. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• In a national study, more than half (51%) of the drowning deaths of children 0 to 4 years of age occurred in swimming pools, but a sizable proportion (25%) occurred in ponds, rivers, and lakes. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
  • Older children in the 5- to 14-year age range are slightly more apt to drown in a natural body of water than in a swimming pool, but a high proportion (69%) of adolescents 15 to 19 years of age drowned in fresh bodies of water. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
    • In a study from Washington state, open-water drowning occurred in 35% of those in the 0- to 4-year age group, 69% of those in the 5- to 14-year age group, and 95% of adolescents. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
    • Regarding nonfatal drowning in children and adults, 66% occurred in pools, 22% occurred in natural water, and 12% were unspecified. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Above-Ground Inflatable and Portable Pools
Recently there was an increase in sales of large, inexpensive, inflatable or portable above-ground pools that come in various sizes, shapes, and water depths. The pools are 18 to 48 in deep and can hold less than 200 to more than 5000 gallons of water. Some models even require filtration equipment. Prices range from $50 to $750. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

• From 2004 to 2006, the CPSC reported 47 deaths of children related to inflatable pools.  Unfortunately, many parents do not consider fencing for an inflatable or portable pool, and such pools often fall outside of local building codes that require pool barriers. Because they contain such large amounts of water, these pools are often left filled for weeks at a time, which presents a continuous danger. The soft sides of some models allow children to lean over and easily fall into the pool headfirst. In a study of above-ground pools, children between 42 and 54 months of age were shown to be able to climb into a pool with a 48-in wall, even if the ladder was removed.  The American Society for Testing and Materials (ASTM) has published a standard (F 2666-07) for above-ground pools for residential use that addresses structural integrity, sanitation, electrical safety, and safety-message labeling. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Drain Entrapment
From 1990 to 2004, 74 cases (13 deaths) of body entrapment in a pool or spa drain were reported to the CPSC.  In a separate report, 24 additional cases (2 deaths) were reported in just the 3 years from 2005 to 2007.  The situation often involves a child playing with an open drain, inserting a hand or foot into the pipe, and then becoming trapped by increasing suction and resulting tissue swelling. The deaths were from drowning. The majority (77%) of the victims were younger than 15 years. In the same time period (1990–2004), 43 incidents (12 deaths) of hair entanglement were reported.  These incidents typically involve females with long hair who are underwater near a suction outlet. The water flow into the drain sweeps the hair into and around the drain cover, where it becomes tangled in the holes and protrusions of the cover. Almost all (92%) of these cases were also in children younger than 15 years. In addition, there have been 2 incidents of evisceration and disembowelment that have occurred when a young child sat on and was sucked into a drain with a missing cover. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Entrapment and entanglement can be prevented by the use of special drain covers, safety vacuum-release systems (SVRSs), filter pumps with multiple drains, and a variety of other pressure-venting filter-construction techniques.  Unfortunately, many parents and pool and spa owners are not aware of entrapment/entanglement risk, and only 15% have installed antivortex drain covers, only 14% have multiple drain systems, and only 12% have an SVRS on their pool or spa.  In 2007, Congress passed the Virginia Graeme Baker Pool and Spa Safety Act, which requires drain covers, unblockable drains, and SVRSs for all public pools and spas in the United States.  Although the act does not apply to private pools, all pool owners should implement the recommendations reflected in the act. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Lapses in Adult Supervision
Drowning is not generally associated with a complete lack of adult supervision but, rather, with a momentary lapse in supervision. In fact, in a study of 496 drowning deaths in children younger than 14 years that were reviewed by state child-death review teams, only 10% were completely unsupervised at the time of the drowning. Most of the children (68%) were expected to be in or near the water just before the drowning incident.  In a questionnaire portion of the same study, parents of children younger than 14 years admitted that they talk to others (38%), read (18%), eat (17%), and talk on the telephone (11%) while supervising their child near water. Attempts to attribute cause to 538 swimming-pool submersion incidents of children younger than 5 years in Maricopa County revealed seasonal differences (warm versus cold months) and differences related to outcome (fatal versus nonfatal). In winter months, both with fatal and nonfatal cases, lack of a barrier and broken fences and gates were responsible for most (76%) cases, and poor supervision was blamed in only 16% of the cases. During warm months, lapses in supervision were responsible for 62% of nonfatal cases; however, lack of a barrier and broken fences and gates were responsible for most (70%) of the deaths.  Fencing is clearly important all year round. Overall, nonfunctioning gates were the cause of 17% of all pool drowning incidents in this study. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Alcohol
A recent meta-analysis revealed that 30% to 70% of swimming and boating fatal drowning victims had a measurable blood alcohol concentration (BAC) and that 10% to 30% of those deaths could be attributed specifically to alcohol use.  In boating, there is evidence that the relative risk of drowning death is directly related to BAC, with a 16-fold greater risk when the victim’s BAC was more than 0.10 (100 mg/dL).  Alcohol intake may increase the risk of drowning not only by impairing judgment and performance but also through physiologic effects (ie, impaired orientation, hypothermia) that affect survival once submersion occurs.  Little information is available regarding the association of drug use and drowning. One 10-year retrospective study from Ohio revealed that only 3% of 141 accidental drowning deaths were associated with illicit drugs. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Swimming Ability
Few studies have examined the relationship between swimming ability and the risk of drowning, and there is no clear evidence that drowning rates are higher in poor swimmers.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

• Increased swimming proficiency might lead to an increase in drowning rates through an increased exposure to water and dangerous aquatic situations.  A CPSC study of 140 swimming-pool child-drowning deaths revealed that better swimming ability, as reported by the parents, was associated with lower drowning risk.  An 8- to 12-week training course for preschool-aged (24–42 months) children revealed that the subjects were able to develop the water-safety skills necessary to survive a fall into a home swimming pool. With training, the young children could stand and recover when dropped into 2 ft of water, kick propulsively, and get to the side of the pool after jumping in or being released in the pool by an adult. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• Two recent case-control studies revealed that swimming lessons may reduce drowning risk in small children. A study from rural China that examined drowning deaths in children 1 to 4 years of age revealed that drowning “case” children were less likely to have had swimming lessons than were controls (6.8% vs 12%, respectively). Research on 61 drowning deaths in children 1 to 4 years of age (mean age: 2.62 years) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development revealed that the drowning victims were reportedly less likely (3% vs 26%) to have participated in formal swimming lessons (odds ratio [OR]: 0.05 [95% confidence interval (CI): 0.01–0.34]; P = .002) and were less likely (5% vs 18%) to be able to float on their back for 10 seconds (P = .01). When adjusted for education, race, and risk-taking, formal swimming lessons remained a significant predictor of drowning risk (OR: 0.12 [95% CI: 0.01–0.97]). The authors indicated that “this can be interpreted as an 88% reduction in risk of drowning among those with swimming lessons,< with 95% confidence that a protective effect between 3% and 99% includes the true value.” The study reports did not describe the details of the swim instruction or water-survival skills training. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Although swimming ability may or may not decrease drowning risk, it does not result in “drown-proofing.” A study from the Canadian Red Cross revealed that 16% of those who fatally drowned while swimming had “strong” or “average” swimming skills. In a study of children younger than 5 years from New Zealand, 6 of 36 (17%) of the drowning victims had received swimming instruction. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

In recent years, water-survival skills programs designed for infants younger than 12 months have become popular both in the United States and internationally. Many movies of tiny infants who have been taught to swim underwater, float fully clothed on their backs, and even cry out for help have emerged on the Internet. Although there are anecdotal reports of infants who have “saved themselves,” no scientific study has clearly demonstrated the safety and efficacy of training programs for such young infants. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Underlying Medical Conditions

• Seizure disorder is a known risk factor in drowning. Children with epilepsy are at greater risk of drowning in bathtubs as well as in swimming pools. The relative risk of submersion events and drowning deaths in patients with epilepsy varies greatly from study to study and depends on such factors as age, severity of illness, degree of exposure to water, and level of supervision. There is some evidence from studies with small numbers of patients that children with autism spectrum disorders are at higher risk of drowning than those in the general population. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• The risk in children with autism seems to be higher with greater degrees of mental retardation. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• For children without autism, no study has specifically studied developmental disabilities or attention-deficit/hyperactivity disorder as drowning risk factors.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• In individuals with long QT syndrome, exertion from swimming may trigger an arrhythmia.  Although such cases represent a small percentage of drownings, this syndrome should be considered as a possible cause for unexplained submersion injuries among proficient swimmers in low-risk settings. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

Boating
In 2008, the US Coast Guard reported 71 boating deaths of individuals 19 years and younger, with 53 (75%) attributed to drowning. Eighty-five of the 669 injuries in this age group occurred while riding in an open motorboat or personal watercraft.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)

• Analysis of all fatal boating incidents has revealed that 79% of the operators had no boating training, and 22% of the incidents involved alcohol. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• The vast majority of boating drowning deaths (90%) occur in individuals not wearing a personal flotation device (PFD). (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
• For children younger than 14 years, it is reported that nearly 45% of those who died in a boating-related incident were not wearing a life jacket. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
  • Federal law requires life-jacket use for children younger than 13 years on recreational boats in the United States.  (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
  • One observational study revealed that 90% of children younger than 5 years wore life jackets, but only 13% of those 14 years or older used a life jacket. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
  • Reasons commonly cited for not wearing a life jacket include beliefs that there is a low risk of drowning, that life jackets restrict movement, that life jackets are uncomfortable, that life jackets are unattractive, and that wearing a life jacket is a sign of fear. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)
  • Parents of children who do not always wear life jackets report reasons including (1) the parent is in close proximity to the child, (2) a PFD for the child is on board in case of emergency, and/or (3) the child has good swimming skills. (”Prevention of Drowning”; PEDIATRICS Vol. 126 No. 1 July 2010, pp. e253-e262.  Published online May 24, 2010.)