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Drowning --- Louisiana, 1998

Drowning is the third leading cause of death from unintentional injuries in Louisiana. In 1998, the fatality rate from drowning for Louisiana residents was 3.1 per 100,000 population, higher than the U.S. rate of 1.9 per 100,000, and more than twice the 2000 national target of 1.3 per 100,000 population. This report describes the demographics and risk factors associated with drownings in Louisiana in 1998. Findings indicate that alcohol or illicit drug use was found in approximately 60% of tested victims aged >13 years and that none of the victims of boating-related drowning were correctly wearing a personal flotation device (PFD). Prevention efforts should focus on decreasing alcohol and illicit drug use and increasing the proper use of PFDs among boaters and others involved in water recreation.

The Louisiana Office of Public Health examined three sources of data on persons who died by drowning: 1998 death certificates, coroners' records, and records of investigations performed by the Louisiana Department of Wildlife and Fisheries (LDWF). A case was defined as death in a resident of Louisiana coded on the death certificate as having drowned in the state during 1998. Using death certificates, 137 cases were identified. Of these, 114 investigative reports were reviewed: 96 with coroners' records, six with LDWF reports, and 12 with both; investigative reports for 23 (17%) cases could not be obtained. In addition, modifiable risk factors were analyzed. Alcohol and illicit drug use were examined in the deaths of persons aged >13 years. Use was determined by the presence of ethanol or metabolites of illicit drugs in samples collected at autopsy. Among deaths that occurred in a swimming pool, pool fencing was described as present or absent, and PFD use was recorded for investigative reports of boating-related drowning.

Of the 137 drowning cases, 115 (84%) occurred among males. Blacks and whites died in almost equal numbers, 68 (50%) and 67 (49%), respectively; however, the rate of drowning among blacks was more than twice the rate of whites, 4.8 per 100,000 and 2.3 per 100,000, respectively. The median age of drowned persons was 32 years (range: 10 months--94 years). The highest drowning rate was among persons aged 25--35 years (3.8 per 100,000). Children aged <4 years accounted for 10% of the total deaths and had the second highest rate (3.5 per 100,000). Among those cases in which the manner of death could be determined, 122 (95%) were classified as "accident" (unintentional); seven (5%) were classified as suicide. Twelve (9%) drowning deaths were work-related.

Of 114 deaths with coroner or LDWF records, 83 (73%) occurred in natural bodies of water (e.g., lakes, bayous, rivers, and the Gulf of Mexico), 19 (17%) in swimming pools, and seven (6%) in bathtubs or hot tubs. Four deaths were classified to have occurred in an "other setting" and in one death the setting was unknown. Alcohol testing was recorded in 72 (76%) of the 94 decedents aged >13 years; 43 (60%) had evidence for the presence of alcohol and/or illicit drugs. Thirteen (30%) decedents were positive for alcohol and illicit drugs, 28 (67%) were positive for alcohol, and one (2%) was positive for illicit drugs.

Among the 19 deaths that occurred in a swimming pool, 11 (58%) were in children aged <14 years. Children aged <4 years died in swimming pools at the highest rate (1.3 per 100,000). The presence or absence of fences was noted in eight (42%) deaths. Six pools had and two did not have fencing.

Coroner and LDWF reports indicated that 35 (31%) of 114 deaths occurred during boating-related activities: 11 (31%) involved a fall from the boat, seven (20%) occurred when the boat capsized, and six (17%) involved a collision. Five (14%) persons who drowned had entered the water voluntarily, and six (17%) had entered the water for unknown reasons. PFD use was recorded for 22 (63%) boating-related drownings; only one decedent had been wearing a PFD and it was unfastened. Among persons aged >13 years, 34 drownings occurred; 13 (48%) tested positive for alcohol or illicit drugs.

Reported by: M Kohn, MD, Health Div, Oregon Dept of Human Svcs. R Duthu, Louisiana Dept of Wildlife and Fisheries; H Flood, MPH, G Hall, J Wiley, MHSE, H Benson Kutinac, MPH, Louisiana Office of Public Health. State Br, Div of Applied Public Health Training, Epidemiology Program Office; National Center for Injury Prevention and Control; and an EIS Officer, CDC.

Editorial Note:

The circumstances of drowning identified in this report highlight ways to prevent drowning deaths. Drowning in Louisiana occurred most often in natural bodies of water. Approximately 30% of the deaths during 1998 were associated with boating, which is proportionately more than in the entire United States, where boating accounts for 20% of drowning (1). In this investigation, the findings indicated that alcohol or illicit drug use was present in nearly half of the tested boating-related deaths among persons aged >13 years, that none of the boating-related decedents had been wearing a PFD correctly, and that during 1998, drowning in swimming pools accounted for 17% of deaths, with children aged <4 years at highest risk. Louisiana state regulations pertaining to alcohol use focus only on boat operators, and state regulations on wearing PFD pertain only to children aged <13 years.

The findings in this report are subject to at least two limitations. First, some investigative reports were not available. Second, risk factor information was missing in many of the reports that were examined. Both of these limitations could effect the reported prevalence of risk behaviors.

By analyzing the state-level data described in this report, the Louisiana Office of Public Health determined that drowning prevention efforts should include: 1) decreasing alcohol and illicit drug use among both boating passengers and operators; 2) focusing on the proper use of PFDs not only among children but among persons of all ages; and 3) instructing caretakers to supervise children and maintain adequate fencing around swimming pools (2). For a pool fence to protect against drowning, the fence must completely enclose the pool and must be at least 4 feet high with vertical openings <4 inches wide and with a functional self-latching gate (3). All of these prevention efforts need to be delivered in a manner culturally appropriate for the highest risk populations.

References

  1. Baker SP, O'Neill B, Ginsburg M. The injury fact book. New York, New York: Oxford University Press, 1992.
  2. Wintemute GJ. Childhood drowning and near---drowning in the United States. Am J Dis Child 1990;144:663--9.
  3. US Consumer Product Safety Commission. Children and pools: a safety checklist. Washington, DC: US Consumer Product Safety Commission, 1993; publication no. 357.

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