Perspectives in Disease Prevention and Health Promotion Drownings -- Georgia, 1981-1983

Drownings are the second most frequent cause of death from unintentional injuries in Georgia among persons under 30 years of age. Data obtained from the Georgia Office of Vital Records and the Georgia Department of Natural Resources show that, overall, from 1981 through 1983, 573 drownings occurred in Georgia. Excluding 26 drownings among residents of other states, the annual fatality rate (drownings per 100,000 population) for Georgia residents was 3.2/100,000. These drownings accounted for an estimated 17,616 potential years of life lost among Georgia residents. Most drownings (66%) occurred from May through August, and 40% occurred on Saturdays and Sundays.

Although it is generally assumed that most aquatic deaths occur in swimming pools, pools accounted for only 75 (14%) of all reported drownings among Georgia residents (Table 1). Lakes, ponds, farm ponds, and borrow pits accounted for 249 (46%), and rivers and creeks, for 140 (26%) of all drownings.

Forty-five percent of drownings occurred while the person was swimming--the most for any category--and males accounted for 91% of these. The other activities that led to drowning included falling into the water (18%); boating (12%), which includes water skiing; bathtub use (6%); wading (5%); fishing (1%); attempts to rescue a drowning victim (1%); and other or unknown causes (12%).

Drowning fatality rates differed by the age, race, and sex of the victim (Figure 1). Overall, rates were highest for children under 5 years of age and for young adults aged 15-24 years. Although not shown in Figure 1, the highest rate was for children under 1 year of age (6.2/100,000 children in that age group). Sixty-nine percent of the drowning victims under 1 year of age drowned in a bathtub. Except for children under 5 years old, black males had the highest drowning fatality rates for each age group. Overall, the rate for black males was 1.9 times greater than that for white males (8.6 deaths/100,000 black males, compared with 4.6 deaths/100,000 white males, respectively) (p 0.005). Forty-four percent of all swimming-related fatalities occurred among black males.

Regardless of race, males were at greater risk of drowning than females (5.7 deaths/100,000 males, compared with 0.9 deaths/100,000 females, respectively) (p 0.001). There was no appreciable difference in risk between white females and black females. However, the drowning fatality rate for all blacks was 1.7 times greater than that for all whites (4.5 deaths/100,000 blacks, compared with 2.7 deaths/100,000 whites, respectively) (p 0.001). This difference in risk is due to the much greater risk for black males than for white males. Reported by JD Smith, RA Marcus, MPH, RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human Resources, J Brown, Georgia Dept of Natural Resources; Special Studies Br, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Nationwide, drowning ranks third among causes of death from unintentional injury among all age groups and ranks second for ages 5-44 years. Also, the overall drowning rate for blacks is about twice that for whites. The fatality rates reported here for Georgia are similar to national rates. Of the 7,000 unintentional drownings occurring each year in the United States, about 17% involve boats, primarily recreational craft, and about 10% occur in and around the home. Most home-related drownings occur in swimming pools and bathtubs; each year, about 250 children aged 1-4 years drown in swimming pools, predominantly home pools. However, a 1971 survey suggested that about 80% of drownings occur at other than designated swimming areas (1,2).

Many complex factors, host as well as environmental, are associated with drownings. Previous studies found that alcohol use was associated with about 50% of drownings among teenagers and adults (3,4).

The rates per 100,000 persons of both boat-related drownings and drownings not related to boats have remained relatively stable over the past 2 decades (1). However, this may be a reflection of progress in controlling drownings. For example, U.S. Coast Guard data indicate that, despite a 59% increase in the number of recreational craft in operation from 1973 to 1983, the recreational boating fatality rate (about 90% of which is represented by drownings) has decreased steadily from 18.3 fatalities/100,000 recreational craft in 1973 to 8.1/100,000 in 1983. Although the causes for this decrease have not been determined, they may include industry and government initiatives that have resulted in safety improvements in boats, increased use of personal flotation devices, and regulations that promote safe boating (5).

The broader application and evaluation of a similar comprehensive mix of strategies that includes surveillance, education, the application of available control technologies, the development and enforcement of regulations, and the improvement of emergency response capability may lead to equally impressive reductions in fatality rates not associated with boats (1,6-8). For example, child-proof fencing with self-latching gates around dangerous bodies of water, including swimming pools, may reduce the rate of drowning among young children (9).

Many drownings occur among young people, and fatality rates are especially high among males 15-24 years of age. The reasons for the high fatality rate in otherwise healthy, physically capable young males are unclear. Further studies should focus on swimming ability, hazardous activities, behavior, alcohol and other drug exposures, and the estimated amount of exposure to bodies of water as possible influences on the drowning rate.

References

1. Baker SP, O'Neill B, Karpf RS. The injury fact book. Lexington, Massachusetts: Lexington Books, 1984.

2. National Safety Council. Accident facts, 1984. Chicago: National Safety Council, 1984.

3. Dietz PE, Baker SP. Drowning: epidemiology and prevention. Am J Public Health 1974;64:303-12.

4. Haberman PW, Baden MM. Alcohol, other drugs and violent death. New York: Oxford University Press, 1978.

5. U.S. Coast Guard. Boating statistics, 1983. Washington, D.C.: U.S. Department of Transportation, 1984 (publication no. COMDTINST M16754.1E).

6. CDC. Aquatic deaths and injuries--United States. MMWR 1982;31:417-9.

7. Robertson LS. Injuries--causes, control strategies, and public policy. Lexington, Massachusetts: Lexington Books, 1983.

8. Waller JA. Injury control--a guide to the causes and prevention of trauma. Lexington, Massachusetts: Lexington Books, 1985.

9. Pearn JH, Wong RYK, Brown J, et al. Drowning and near-drowning involving children: a five-year total population study from the city and county of Honolulu. Am J Public Health 1979;69:450-4.

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