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Risk factors for fatal drowning in a Greek region: a retrospective case–control study
  1. Dimitrios Phaedon Kevrekidis1,
  2. Evdokia Brousa1,
  3. Orthodoxia Mastrogianni2,
  4. Amvrosios Orfanidis1,
  5. Helen G Gika1,
  6. Nikolaos Raikos1
  1. 1Laboratory of Forensic Medicine and Toxicology, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
  2. 2Laboratory of Toxicology, Forensic Service of Thessaloniki, Thessaloniki, Greece
  1. Correspondence to Professor Nikolaos Raikos, Laboratory of Forensic Medicine and Toxicology, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece; raikos{at}


Background Fatal drowning is one of the leading causes of unintentional injury mortality worldwide and a persistent public health concern in Greece. While several pathologic and sociodemographic contributing factors have been previously identified, these have not been extensively investigated in conjunction with the effects of psychoactive substances.

Methods A retrospective case–control study of drowning deaths was conducted in the Greek regions of Northern Greece and Thessaly during a 10-year period. A regression model was constructed examining differences in detected substances, autopsy findings and sociodemographic characteristics between 240 victims of unintentional fatal submersion and 480 victims of other causes of sudden or violent death.

Results The majority of victims were males (69.4%) and foreign nationality was associated with increased odds of drowning. Cardiomegaly and coronary bypass grafts were significantly more likely to have been recorded among drowning victims, while the frequency of other circulatory system disorders was also elevated. Several of these findings were potential arrhythmogenic substrates which could adversely interact with the diving reflex. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly detected pharmacological group (9.0%), and along with tramadol, there was an increased likelihood of exposure to them. These drugs have been previously associated with QT prolongation and other adverse effects which may contribute to fatal outcomes in a seawater environment. In contrast, there was a decreased risk of exposure to dependence-inducing drugs and paracetamol.

Conclusions Male sex, older age, foreign nationality and cardiovascular disease predisposed individuals to an elevated risk of fatal submersion. SSRI antidepressants and tramadol may contribute to this outcome.

  • drowning
  • case–control study
  • epidemiology
  • qualitative research
  • risk factor research
  • mortality

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  • Contributors DPK designed the study and collected, analysed and interpreted the data and wrote the original draft. EB collected the data and contributed to the writing of the original draft. OM conceptualised the study and participated in the supervision, review and edit of the final draft along with AO, HGG and NR. The final text was approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on this map does 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. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available on reasonable request. De-identified participant data are available on reasonable request from corresponding author.

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