Current Trends North Carolina Drownings, 1980-1984

Unintentional drownings in North Carolina in the period 1980-1984 were examined using records obtained from the North Carolina Office of the Chief Medical Examiner, which investigates all deaths from intentional and unintentional injury. A total of 1,052 persons drowned in the 5-year period, 953 of whom were North Carolina residents, for an average annual crude mortality rate of 3.2 drowning deaths/100,000 residents (Table 1).

Drowning rates per 100,000 population were higher for nonwhites than for whites (4.8 vs. 2.6) and higher for males than for females (5.8 vs. 0.8). Rates were highest for nonwhite males (8.8), followed by white males (4.7), nonwhite females (1.2), and white females (0.7) (Table 1). For all race/sex groups combined, drowning rates were highest for persons ages 15-29 years (4.6/100,000) (Table 2).

Most drownings occurred in lakes or ponds (39%), rivers or creeks (29%), or oceans and bays (11%). Six times as many drownings occurred in natural settings as in constructed facilities (e.g., bathtubs, pools).

At the time drownings occurred, most victims were swimming (41%) or fishing (15%) (Table 3). Drownings among members of certain demographic subgroups and among persons with some pre-existing medical conditions showed special associations with specific activities. For example, males accounted for 98% of all fishing deaths, and females accounted for 43% of all bath-associated deaths. White males accounted for a higher percentage (82%) of other recreational deaths (e.g., canoeing, sailing) than they did for all categories of drownings (56%). Children less than 5 years of age accounted for a higher percentage (25%) of bath-associated deaths than they did for all categories of drownings (6%). Although only 7% of all drowning victims were known to have seizure disorders, persons with seizure disorders accounted for 53% of all drownings resulting from bathing in a bathtub.

Of all drownings, 56% were witnessed. However, the proportion of drownings that were witnessed ranged from 92% for swimming in a group to 3% for bathing in a bathtub. Of the 74 children ages 0-5 years who drowned, 59 (80%) were unattended. Of all persons who drowned, 2% drowned while attempting to rescue other drowning persons.

Blood-alcohol tests were performed for 839 (80%) of the 1,052 drowning victims. Alcohol was detected in 48% of victims tested; in 34% of victims tested, blood-alcohol levels were greater than or equal to 100 mg%,* the legal level of intoxication in North Carolina. Blood-alcohol presence varied by demographic subgroup and predominated among nonwhite males (40%) and 30- to 44-year-olds (50%) (Tables 1 and 2). Reported by M Patetta, MA, State Center for Health Statistics, P Biddinger, MD, Office of the Chief Medical Examiner, J Freeman, DVM, MPH, Environmental Epidemiology Branch, JN MacCormack, MD, State Epidemiologist, North Carolina Division of Health Services; Division of Field Services, Epidemiology Program Office, Division of Injury Epidemiology and Control, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Drowning is the third most common cause of unintentional injury death in the United States (2). Drowning rates reported for North Carolina are higher than the overall national drowning rate of 2.4/100,000 population (1,2). Although most surveys of drowning consist of data derived from death certificate ICD codes, the North Carolina data reported here were abstracted from medical examiner reports, which also include findings of an investigation by a county medical examiner, autopsy reports, and toxicologic studies.

Age, race, and sex groups at highest risk for drowning in North Carolina are similar to those reported in national data (1). The proportions of North Carolina drownings occurring in lakes/ponds and rivers/creeks are similar to those reported for Georgia (3); however, the occurrence of drownings in natural settings relative to those in constructed facilities is proportionately higher. The proportions of drownings resulting from activities such as swimming and fishing (sometimes reported in other studies as "falling off docks or bridges") are similar to those reported from national surveys (2) and from other states (3,4).

Studies based on death certificates generally do not permit assessment of the impact of pre-existing medical conditions on drowning occurrence, because such information may not be provided in death certificates. The North Carolina data support the hypothesis that persons with seizure disorders are at higher risk for drowning than the general population (4,5); persons with seizure disorders are more likely to have a seizure following alcohol intoxication (6,7).

Because approaches to limiting the consumption of alcohol may be difficult to enforce, efforts should be made to increase public awareness of the physical impairments resulting from alcohol use which pose risks for swimmers, fishermen, and boaters. Strategies for injury prevention rely primarily on elimination of the hazard, creation of barriers between the hazard and the person at risk, instruction in personal protective measures against the hazard, and institution of measures to minimize damage associated with the hazard (8). In addition to human behavioral factors, intervention should focus on the modification of factors in the socioeconomic environment, as well as such factors as vehicles and equipment in the physical environment. Previous studies showed that alcohol was associated with about 50% of drownings among teenagers and adults (4). Enforcing limitations on the consumption of alcohol near water is difficult, although public awareness that the physical impairment resulting from alcohol use is as dangerous for swimmers, fishermen, and boaters as it is for motor vehicle operators could almost certainly be improved. Additionally, it must be realized that alcohol consumption among some high-risk individuals (e.g., 15- to 24-years olds) is highly affected by the accessibility of alcohol. Sales and consumption of alcohol among this group are inversely related to the cost of alcohol (9). Recent upward alterations in the legal drinking age may lead to reductions in mortality associated with drowning.

Seventy-nine percent of North Carolina drowning deaths occurred in such natural settings as lakes, rivers, and bays. Of the 7,000 unintentional drownings that occur each year in the United States, about 17% involve boats--primarily recreational craft (3). Despite a 59% increase in the number of recreational craft in operation in the United States between 1973 and 1982, the recreational boating fatality rate (about 90% due to drownings) decreased 56% during the same period (3). Although the causes for this decrease have not been determined, they may include industry and government initiatives that have resulted in safety improvement in boats, increased use of personal flotation devices, and regulations that promote safe boating. Water safety instruction should be designed to lead to improvements in swimming ability, discourage risk-taking behavior such as alcohol use near water, encourage the use of personal flotation devices on boats, and teach rescue techniques that do not endanger the life of the rescuer. However, studies of the efficacy of water safety instruction programs are needed before such instruction is advocated as an effective intervention technique (10).

Although most North Carolina drownings do not occur in settings--such as pools--that could be fenced or drained when not in use, in the United States as a whole, most home-related drownings do occur in swimming pools and bathtubs. Therefore, child-proof fencing with self-latching gates aroung potentially dangerous bodies of water, including swimmings pools, may reduce drowning among young children (11).

References

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

2. National Safety Council. Accidents facts, 1985. Chicago, Illinois: National Safety Council, 1985.

3. CDC. Drownings--Georgia, 1981-1983. MMWR 1985;34:281-3.

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

5. Greensher J. Prevention of childhood injuries. Pediatrics 1984;74:970-5.

6. Pearn J. Drowning and alcohol. Med J Aust 1984;141:6-7.

7. Plueckhahn VD. Alcohol and accidental drowning. A 25-year study. Med J Aust 1984;141:22-5.

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

9. Mosher JF, Beauchamp DE. Justifying alcohol taxes to public officials. J Public Health Policy 1983 (December):422-39.

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

11. Hearn 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 Pub Health 1979;69:450-4. *The level of alcohol in the blood is defined as "milligrams of alcohol per 100 milliliters of blood" and is expressed as milligrams percent (mg%).

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