Bollettino epidemiologico nazionale

Drowning Deaths in Italy

Marco Guistini¹, Franco Taggi^1, and Enzo Funari²

¹Laboratory of Epidemiology and Biostatistics, ISS
²Laboratory of Environmental Health, ISS

Drowning and spinal injuries resulting from water recreation activities are serious events that often affect younger persons who otherwise would have had many years of active life ahead of them. The loss of life of a young person and the serious sequelae of near-drownings and spinal injuries result in both major suffering and high social costs.

In Italy, data are not available on the morbidity associated with drowning. However, national mortality data available from the Italian Institute of Statistics (ISTAT) permit an evaluation in trends and characteristics associated with drowning deaths for 1969 to 1998, the most recent year for which data are available. For purposes of this analysis, those deaths with an ICD-9 code of E910 were identified. Additionally, those with the codes E830-E838, which refer to deaths secondary to injury sustained during water transport, were included in the analysis.

Between 1969 and 1998, 24,496 persons died from drowning, of whom 81.9% were males. Relatively few of these deaths (approximately 10% during the last 10 years) resulted from water transport accidents. Approximately 42% of the deaths occurred outside the victim’s province of residence.

The characteristics of persons who died from drowning in 1970, 1980, 1990, and 1998 are shown in the Table. The death rate decreased from 22.7 to 5.2 deaths per million residents annually over the study period, representing a 77% decline. The decline occurred for both males and females, resulting in a stable male: female ratio of 5:1.

When trends were examined by age, the data demonstrate that the greatest declines have occurred in the youngest age groups. In 1998, the highest death rates was in the 70 years and over age group (9.4/million, followed by those 15-29 years of age (6.1/million) and those between the ages of  50-69 years (5.9/million).

As a result of the different rates of decline in the various age groups, the distribution of deaths by age has also undergone considerable change.  While in 1969, one out of 4 deaths occurred in children 14 years and under, in 1998 less than 8% of the deaths occurred in this group. Corresponding increases have occurred in older age groups, with the percentage of deaths in the 30-49 year age group increased from 15.5% to 23.2% between 1969 and 1998, from 17.8% to 25.1 in those 50-69 years of age, and from 9.0 to 19.1% in those 70 years and older.

Many factors have contributed to the radical changes that have occurred in the epidemiologic profie of drowning deaths in Italy. Certainly a part of the decline observed is attributable to the greater probability of survival resulting from the availability of intensive care units and the presence of rescue personnel with skills in rapid resuscitation. Other factors include the increased role of education by the schools and family as well as by the media on means of reducing the risk of drowning.

In Italy, the male:female ratio is slightly higher than that reported in other countries (1-3), where the ratio is usually 4:1. The reasons behind the elevated sex ratio may include that males in Italy are more frequently in contact with the acquatic invironment compared with their female counterpartts (both for occupational and recreational purposes) and that they consume more alcohol, which is known to be one of the principal risk factors for drowning (4). Alcohol, in fact, results in a diminished capacity to react to problems and at the same time leads persons to under-evaluate their level of risk. With respect to children, lack of adult supervision is a major risk factor for drowning.

Although the current data are sufficient to develop intervention programs, efforts to collect further data on causes and risk factors for drowning would be useful in further refining prevention strategies. Useful data might include the setting where the drowning occurred (river, lake ocean, pool, supervised beach, etc); environmental factors, both environmental (currents, water temperature, etc) and individual (pre-existing conditions or illness); and the type of activity in which the person was engaged at the time of the drowning (diving, swimming, fishing from a pier, a boat, a rocky shore, etc).

Nonetheless, in the absence of more specific data, certain general measures should be instituted that can reduce the risk of drowning. These include dissemination of information about risks associated with the consumption of alcohol, better adults supervision of children, improvements in swimming skills, and an improvements in first aid and emergency responses, especially among lifeguards.

REFERENCES

1.Rouse A. West Engl Med J 1991; 106(3): 65-6.
2.Langley JD, Warner M, Smith GS, et al. Aust N Z J Public Health 2001; 25(5): 451-7.
3. http://www.cdc.gov/ncipc/factsheets/drown.htm
4.Lunetta P, Penttila A, Sarna S. Int J Epid 1998; 27: 1043-83.