Article Text

The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study
  1. Richard Charles Franklin1,2,
  2. Amy E Peden2,3,
  3. Erin B Hamilton4,
  4. Catherine Bisignano4,
  5. Chris D Castle4,
  6. Zachary V Dingels4,
  7. Simon I Hay4,5,
  8. Zichen Liu4,
  9. Ali H Mokdad4,5,
  10. Nicholas L S Roberts4,
  11. Dillon O Sylte4,
  12. Theo Vos4,5,
  13. Gdiom Gebreheat Abady6,
  14. Akine Eshete Abosetugn7,
  15. Rushdia Ahmed8,9,
  16. Fares Alahdab10,
  17. Catalina Liliana Andrei11,
  18. Carl Abelardo T Antonio12,13,
  19. Jalal Arabloo14,
  20. Aseb Arba Kinfe Arba15,
  21. Ashish D Badiye16,
  22. Shankar M Bakkannavar17,
  23. Maciej Banach18,19,
  24. Palash Chandra Banik20,
  25. Amrit Banstola21,
  26. Suzanne Lyn Barker-Collo22,
  27. Akbar Barzegar23,
  28. Mohsen Bayati24,
  29. Pankaj Bhardwaj25,26,
  30. Soumyadeep Bhaumik27,
  31. Zulfiqar A Bhutta28,29,
  32. Ali Bijani30,
  33. Archith Boloor31,
  34. Félix Carvalho32,
  35. Mohiuddin Ahsanul Kabir Chowdhury33,34,
  36. Dinh-Toi Chu35,
  37. Samantha M Colquhoun36,
  38. Henok Dagne37,
  39. Baye Dagnew38,
  40. Lalit Dandona4,5,39,
  41. Rakhi Dandona4,39,
  42. Ahmad Daryani40,
  43. Samath Dhamminda Dharmaratne4,41,
  44. Zahra Sadat Dibaji Forooshani42,
  45. Hoa Thi Do43,
  46. Tim Robert Driscoll44,
  47. Arielle Wilder Eagan45,46,
  48. Ziad El-Khatib47,48,
  49. Eduarda Fernandes49,
  50. Irina Filip50,51,
  51. Florian Fischer52,
  52. Berhe Gebremichael53,
  53. Gaurav Gupta54,
  54. Juanita A Haagsma55,
  55. Shoaib Hassan56,
  56. Delia Hendrie57,
  57. Chi Linh Hoang58,
  58. Michael K Hole59,
  59. Ramesh Holla60,
  60. Sorin Hostiuc61,62,
  61. Mowafa Househ63,64,
  62. Olayinka Stephen Ilesanmi65,
  63. Leeberk Raja Inbaraj66,
  64. Seyed Sina Naghibi Irvani67,
  65. M Mofizul Islam68,
  66. Rebecca Q Ivers69,
  67. Achala Upendra Jayatilleke70,71,
  68. Farahnaz Joukar72,
  69. Rohollah Kalhor73,74,
  70. Tanuj Kanchan75,
  71. Neeti Kapoor16,
  72. Amir Kasaeian76,77,
  73. Maseer Khan78,
  74. Ejaz Ahmad Khan79,
  75. Jagdish Khubchandani80,
  76. Kewal Krishan81,
  77. G Anil Kumar39,
  78. Paolo Lauriola82,
  79. Alan D Lopez4,83,
  80. Mohammed Madadin84,
  81. Marek Majdan85,
  82. Venkatesh Maled86,87,
  83. Navid Manafi88,89,
  84. Ali Manafi90,
  85. Martin McKee91,
  86. Hagazi Gebre Meles92,
  87. Ritesh G Menezes93,
  88. Tuomo J Meretoja94,95,
  89. Ted R Miller57,96,
  90. Prasanna Mithra97,
  91. Abdollah Mohammadian-Hafshejani98,
  92. Reza Mohammadpourhodki99,
  93. Farnam Mohebi100,101,
  94. Mariam Molokhia102,
  95. Ghulam Mustafa103,104,
  96. Ionut Negoi105,106,
  97. Cuong Tat Nguyen107,
  98. Huong Lan Thi Nguyen107,
  99. Andrew T Olagunju108,109,
  100. Tinuke O Olagunju110,
  101. Jagadish Rao Padubidri111,
  102. Keyvan Pakshir112,
  103. Ashish Pathak47,113,
  104. Suzanne Polinder55,
  105. Dimas Ria Angga Pribadi114,
  106. Navid Rabiee115,
  107. Amir Radfar116,117,
  108. Saleem Muhammad Rana118,119,
  109. Jennifer Rickard120,121,
  110. Saeed Safari122,
  111. Payman Salamati123,
  112. Abdallah M Samy124,
  113. Abdur Razzaque Sarker125,
  114. David C Schwebel126,
  115. Subramanian Senthilkumaran127,
  116. Faramarz Shaahmadi128,
  117. Masood Ali Shaikh129,
  118. Jae Il Shin130,131,
  119. Pankaj Kumar Singh132,
  120. Amin Soheili133,134,
  121. Mark A Stokes135,
  122. Hafiz Ansar Rasul Suleria136,
  123. Ingan Ukur Tarigan137,
  124. Mohamad-Hani Temsah138,139,
  125. Berhe Etsay Tesfay140,
  126. Pascual R Valdez141,142,
  127. Yousef Veisani143,
  128. Pengpeng Ye144,
  129. Naohiro Yonemoto145,
  130. Chuanhua Yu146,147,
  131. Hasan Yusefzadeh148,
  132. Sojib Bin Zaman33,149,
  133. Zhi-Jiang Zhang150,
  134. Spencer L James4
  1. 1 College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, Queensland, Australia
  2. 2 Royal Life Saving Society, Sydney, New South Wales, Australia
  3. 3 School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  5. 5 Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
  6. 6 College of Medicine and Health Sciences, Department of Nursing, Adigrat University, Adigrat, Ethiopia
  7. 7 Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
  8. 8 James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  9. 9 Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
  10. 10 Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota, USA
  11. 11 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  12. 12 Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
  13. 13 Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
  14. 14 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  15. 15 Nursing Department, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  16. 16 Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
  17. 17 Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
  18. 18 Department of Hypertension, Medical University of Lodz, Lodz, Poland
  19. 19 Polish Mothers’ Memorial Hospital Research Institute, Lodz, Poland
  20. 20 Department of Non-Communicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
  21. 21 Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
  22. 22 School of Psychology, University of Auckland, Auckland, New Zealand
  23. 23 Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
  24. 24 Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  25. 25 Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
  26. 26 Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Deemed University, Wardha, India
  27. 27 The George Institute for Global Health, New Delhi, India
  28. 28 Centre for Global Child Health, University of Toronto, Toronto, Ontario, Canada
  29. 29 Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  30. 30 Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  31. 31 Department of Internal Medicine, Manipal Academy of Higher Education, Mangalore, India
  32. 32 Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
  33. 33 Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
  34. 34 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
  35. 35 Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
  36. 36 Research School of Population Health, Australian National University, Action, Australian Capital Territory, Australia
  37. 37 Environmental and Occupational Health and Safety, University of Gondar, Gondar, Ethiopia
  38. 38 Department of Human Physiology, University of Gondar, Gondar, Ethiopia
  39. 39 Public Health Foundation of India, Gurugram, India
  40. 40 Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  41. 41 Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  42. 42 Tehran University of Medical Sciences, Tehran, Iran
  43. 43 Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
  44. 44 Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  45. 45 Department of Global Health and Social Medicine, Harvard University, Boston, Massachusetts, USA
  46. 46 Department of Social Services, Tufts Medical Center, Boston, Massachusetts, USA
  47. 47 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  48. 48 World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Québec, Canada
  49. 49 REQUIMTE/LAQV, University of Porto, Porto, Portugal
  50. 50 Psychiatry Department, Kaiser Permanente, Fontana, California, USA
  51. 51 School of Health Sciences, A.T. Still University, Arizona, Missouri, USA
  52. 52 Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
  53. 53 Public Health Department, Haramaya University, Harar, Ethiopia
  54. 54 Non-Communicable Diseases (NCD), World Health Organization (WHO), New Delhi, India
  55. 55 Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
  56. 56 Centre for International Health and Section for Ethics and Health Economics, University of Bergen, Bergen, Norway
  57. 57 School of Public Health, Curtin University, Perth, Western Australia, Australia
  58. 58 Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
  59. 59 Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, Texas, USA
  60. 60 Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
  61. 61 Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  62. 62 Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
  63. 63 Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
  64. 64 Qatar Foundation for Education, Science, and Community Development, Doha, Qatar
  65. 65 Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
  66. 66 Department of Family Medicine, Bangalore Baptist Hospital, Bangalore, India
  67. 67 Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  68. 68 School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
  69. 69 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  70. 70 Institute of Medicine, University of Colombo, Colombo, Sri Lanka
  71. 71 Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
  72. 72 Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
  73. 73 Social Determinants of Health Research Center, Qazvin, Iran
  74. 74 Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
  75. 75 Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
  76. 76 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  77. 77 Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
  78. 78 Epidemiology Department, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
  79. 79 Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
  80. 80 Department of Nutrition and Health Science, Ball State University, Muncie, Indiana, USA
  81. 81 Department of Anthropology, Panjab University, Chandigarh, India
  82. 82 Institute of Clinical Physiology, National Research Council, Pisa, Italy
  83. 83 University of Melbourne, Melbourne, Victoria, Australia
  84. 84 Pathology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  85. 85 Department of Public Health, Trnava University, Trnava, Slovakia
  86. 86 Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India
  87. 87 Health University, Rajiv Gandhi University of Health Sciences, Bangalore, India
  88. 88 Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
  89. 89 Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
  90. 90 Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
  91. 91 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  92. 92 Mekelle University, Mekelle, Ethiopia
  93. 93 Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  94. 94 Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
  95. 95 University of Helsinki, Helsinki, Finland
  96. 96 Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
  97. 97 Community Medicine, Manipal Academy of Higher Education, Mangalore, India
  98. 98 Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
  99. 99 Department of Nursing, Shahroud University of Medical Sciences, Shahroud, Iran
  100. 100 Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  101. 101 Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
  102. 102 Faculty of Life Sciences and Medicine, King’s College London, London, UK
  103. 103 Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
  104. 104 Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
  105. 105 General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  106. 106 General Surgery Department, Emergency Hospital of Bucharest, Bucharest, Romania
  107. 107 Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
  108. 108 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  109. 109 Department of Psychiatry, University of Lagos, Lagos, Nigeria
  110. 110 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  111. 111 Department of Forensic Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
  112. 112 Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
  113. 113 Department of Pediatrics, RD Gardi Medical College, Ujjain, India
  114. 114 Health Sciences Department, Muhammadiyah University of Surakarta, Sukoharjo, Indonesia
  115. 115 Department of Chemistry, Sharif University of Technology, Tehran, Iran
  116. 116 College of Medicine, University of Central Florida, Orlando, Florida, USA
  117. 117 College of Graduate Health Sciences, A.T. Still University, Mesa, Arizona, USA
  118. 118 University Institute of Public Health, University of Lahore, Lahore, Pakistan
  119. 119 Public Health Department, University of Health Sciences, Lahore, Pakistan
  120. 120 Surgery Department, University of Minnesota, Minneapolis, Minnesota, USA
  121. 121 Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
  122. 122 Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  123. 123 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  124. 124 Department of Entomology, Ain Shams University, Cairo, Egypt
  125. 125 Health Economics, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
  126. 126 Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  127. 127 Emergency Department, Manian Medical Centre, Erode, India
  128. 128 Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
  129. 129 Independent Consultant, Karachi, Pakistan
  130. 130 College of Medicine, Yonsei University, Seodaemun-gu, South Korea
  131. 131 Division of Cardiology, Emory University, Atlanta, Georgia, USA
  132. 132 Department of Forensic Medicine, Kathmandu University, Dhulikhel, Nepal
  133. 133 Medical Surgical Nursing Department, Urmia University of Medical Science, Urmia, Iran
  134. 134 Emergency Nursing Department, Semnan University of Medical Sciences, Semnan, Iran
  135. 135 Department of Psychology, Deakin University, Burwood, Victoria, Australia
  136. 136 Department of Agriculture and Food Systems, University of Melbourne, Melbourne, Victoria, Australia
  137. 137 Center for Health Resource and Services Research and Development, National Institute of Health Research & Development, Jakarta, Indonesia
  138. 138 Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
  139. 139 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  140. 140 Department of Public Health, Adigrat University, Adigrat, Ethiopia
  141. 141 Argentine Society of Medicine, Buenos Aires, Argentina
  142. 142 Velez Sarsfield Hospital, Buenos Aires, Argentina
  143. 143 Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
  144. 144 Division of Injury Prevention and Mental Health Improvement, National Center for Chronic and Non-Communicable Disease Control, Chinese Center for Disease Control and Prevention, Beijing, China
  145. 145 Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  146. 146 Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
  147. 147 Global Health Institute, Wuhan University, Wuhan, China
  148. 148 Department of Health Economics and Management, Urmia University of Medical Science, Urmia, Iran
  149. 149 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  150. 150 Department of Preventive Medicine, Wuhan University, Wuhan, China
  1. Correspondence to Dr Spencer L James, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; spencj{at}uw.edu

Abstract

Background Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study’s objective is to describe unintentional drowning using GBD estimates from 1990 to 2017.

Methods Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning.

Results Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes.

Conclusions There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries.

  • drowning
  • burden of disease
  • global
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Footnotes

  • Twitter @Franklin_R_C, @amyepeden

  • Funding This study was funded by the Bill and Melinda Gates Foundation. RCF and AEP were support by funds from the Royal Life Saving Society – Australia.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests Dr. Franklin reports receiving airfare reimbursement from Royal Life Saving Society - Australia, during the conduct of the study. Dr. Bhaumik reports grants from Royal National Lifeboat Institution, UK, outside the submitted work. Dr. Driscoll reports grants from World Health Organization, during the conduct of the study. Dr. Ivers reports grants from Royal National LifeBoat Institute, outside the submitted work. Dr. Khubchandani reports grants from Merck Research Laboratories, outside the submitted work. Dr. James reports grants from Sanofi Pasteur, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Select input data and all outcome results are available at ghdx.healthdata.org.

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