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Trends in drowning mortality in Portugal from 1992 to 2019: comparing Global Burden of Disease and national data
  1. Ana Catarina Queiroga1,2,3,4,
  2. Rui Seabra3,5,6,
  3. Richard Charles Franklin3,7,8,
  4. Amy E Peden3,4,7,8,9
  1. 1Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
  2. 2EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
  3. 3IDRA - International Drowning Researchers' Alliance, Kuna, Idaho, USA
  4. 4Drowning Prevention Commission, International Lifesaving Federation, Leuven, Belgium
  5. 5CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Universidade do Porto, Vairao, Porto, Portugal
  6. 6BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Vairão, Portugal
  7. 7College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
  8. 8Royal Life Saving Society Australia, Broadway, New South Wales, Australia
  9. 9School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Ana Catarina Queiroga, EPIUnit, Institute of Public Health, University of Porto, Rua das Taipas 135, Porto 4050-091, Portugal; queirogaAC{at}gmail.com

Abstract

Introduction Imprecise data systems hinder understanding of drowning burden, even in high-income countries like Portugal, that have a well-implemented death certificate system. Consequently, national studies on drowning mortality are scarce. We aimed to explore drowning mortality in Portugal using national data and to compare these to Global Burden of Disease (GBD) estimates.

Methods Data were obtained from the National Institute of Statistics (INE) for 1992–2019, using International Classification of Diseases (ICD)-9 and ICD-10 codes, by sex, age group and cause (unintentional; water transport and intentional). GBD unintentional drowning data were obtained online. Age-standardised drowning rates were calculated and compared.

Results INE data showed 6057 drowning deaths, 4327 classified as unintentional (75.2% male; 36.7% 35–64 years; 31.5% 65+years; 15.2% 0–19 years). Following 2001, an increase in accidental drowning mortality and corresponding decrease in undetermined intent was observed, coincident with Portugal’s ICD-10 implementation. GBD modelled estimates followed a downward trend at an overall rate of decrease of −0.41/decade (95% CI (−0.45 to –0.37); R2adj=0.94; p<0.05). Conversely, INE data showed an increase in the rate of drowning deaths over the last decade (0.35/decade; 95% CI (−0.18 to 0.89)). GBD estimates were significantly different from the INE dataset (alpha=0.05), either underestimating as much as 0.567*INE in 1996 or overestimating as much as 1.473*INE in 2011.

Conclusions While GBD mortality data estimates are valuable in the absence of routinely collected data, they smooth variations, concealing key advocacy opportunities. Investment in country-level drowning registries enables in-depth analysis of incident circumstances. Such data are essential to informing National Water Safety Plans.

  • surveillance
  • mortality
  • epidemiology
  • policy

Data availability statement

Data used in this study are either available in a public, open access repository or available on reasonable request.

https://doi.org/10.1136/injuryprev-2021-044415

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    Data availability statement

    Data used in this study are either available in a public, open access repository or available on reasonable request.

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    Footnotes

    • Twitter @Franklin_R_C, @amyepeden

    • Contributors All authors have made substantial contributions to all of the following (1) drafting the article or revising it critically for important intellectual content, (2) final approval of the version to be submitted. ACQ and RS were responsible also for data analysis. ACQ is the guarantor for the content of this article.

    • Funding The author RS was funded through national funds CEECIND/01424/2017.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.