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Spatial analysis of paediatric swimming pool submersions by housing type
  1. Rohit P Shenoi1,
  2. Ned Levine2,
  3. Jennifer L Jones1,
  4. Mary H Frost3,
  5. Christine E Koerner4,
  6. John J Fraser Jr4,5
  1. 1Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Texas, USA
  2. 2Ned Levine and Associates, Texas, USA
  3. 3Trauma Services, Texas Children's Hospital, Texas, USA
  4. 4Department of Emergency Medicine, University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Texas USA
  5. 5Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Texas, USA
  1. Correspondence to Dr Rohit P Shenoi, Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin St, Houston, Texas 77030, USA; rshenoi{at}


Objective Drowning is a major cause of unintentional childhood death. The relationship between childhood swimming pool submersions, neighbourhood sociodemographics, housing type and swimming pool location was examined in Harris County, Texas.

Study design and setting Childhood pool submersion incidents were examined for spatial clustering using the Nearest Neighbor Hierarchical Cluster (Nnh) algorithm. To relate submersions to predictive factors, an Markov Chain Monte Carlo (MCMC) Poisson-Lognormal-Conditional Autoregressive (CAR) spatial regression model was tested at the census tract level.

Results There were 260 submersions; 49 were fatal. Forty-two per cent occurred at single-family residences and 36% at multifamily residential buildings. The risk of a submersion was 2.7 times higher for a child at a multifamily than a single-family residence and 28 times more likely in a multifamily swimming pool than a single family pool. However, multifamily submersions were clustered because of the concentration of such buildings with pools. Spatial clustering did not occur in single-family residences. At the tract level, submersions in single-family and multifamily residences were best predicted by the number of pools by housing type and the number of children aged 0–17 by housing type.

Conclusions Paediatric swimming pool submersions in multifamily buildings are spatially clustered. The likelihood of submersions is higher for children who live in multifamily buildings with pools than those who live in single-family homes with pools.

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