ObjectivesFatal drowning estimates using a single underlying cause of death (UCoD) may under-represent the number of drowning deaths. This study explores how data vary by International Classification of Diseases (ICD)-10 coding combinations and the use of multiple underlying causes of death using a national register of drowning deaths.DesignAn analysis of ICD-10 external cause codes of unintentional drowning deaths for the period 2007–2011 as extracted from an Australian total population unintentional drowning database developed by Royal Life Saving Society—Australia (the Database). The study analysed results against three reporting methodologies: primary drowning codes (W65-74), drowning-related codes, plus cases where drowning was identified but not the UCoD.SettingAustralia, 2007–2011.ParticipantsUnintentional fatal drowning cases.ResultsThe Database recorded 1428 drowning deaths. 866 (60.6%) had an UCoD of W65-74 (accidental drowning), 249 (17.2%) cases had an UCoD of either T75.1 (0.2%), V90 (5.5%), V92 (3.5%), X38 (2.4%) or Y21 (5.9%) and 53 (3.7%) lacked ICD coding. Children (aged 0–17 years) were closely aligned (73.9%); however, watercraft (29.2%) and non-aquatic transport (13.0%) were not. When the UCoD and all subsequent causes are used, 67.2% of cases include W65-74 codes. 91.6% of all cases had a drowning code (T75.1, V90, V92, W65-74, X38 and Y21) at any level.ConclusionDefining drowning with the codes W65-74 and using only the UCoD captures 61% of all drowning deaths in Australia. This is unevenly distributed with adults, watercraft and non-aquatic transport-related drowning deaths under-represented. Using a wider inclusion of ICD codes, which are drowning-related and multiple causes of death minimises this under-representation. A narrow approach to counting drowning deaths will negatively impact the design of policy, advocacy and programme planning for prevention.

ObjectivesThe epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning.DesignA subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates.SettingAustralia, 1 July 2002 to 30 June 2015.ParticipantsUnintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation.Results2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0–4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65–74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal.ConclusionsThis study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

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Aim Children aged 5–17 years in Australia have one of the lowest unintentional fatal drowning rates. One possible explanation is the protective effect of formal schooling, reducing leisure time for exposure to water hazards. We examine differences in frequency and circumstances of drowning deaths in this age group between school holidays and school days in Australia. Methods A total population survey (2005–2014) of unintentional fatal drownings was extracted from the (Australian) Royal Life Saving National Fatal Drowning Database. Date of drowning incident and state of residence were used to determine if the drowning occurred during school days or school holidays (including public holidays). Results A total of 188 5–17 year‐olds drowned during the study period. We found a statistically significant difference between drowning incidence during school holidays and school days, with relative risk (RR) of drowning on a holiday 2.40 times higher (confidence interval (CI): 1.82–3.18) than on a school day. This risk was similar for males (RR = 2.41; CI: 1.75–3.33) and females (RR = 2.38; CI: 1.33–4.27) but differs between children 5–9 years (RR = 3.05; CI: 1.98–4.72) and adolescents 10–17 years of age (RR = 2.02; CI: 1.38–2.93). Conclusions Drowning rates among 5–17 year‐olds are more than twice as high during holidays than on school days. Impact of school holidays was the strongest among younger children, visitors to the drowning location and in pools and inland waterways. Results were robust to alternative specifications excluding weekends and treating them as holidays. Prevention strategies may include counselling parents and care providers of the increased risk ahead of school holidays, education on drowning risk in the school curriculum and extra holidays for parents and care givers.

Australia’s celebration of its public holidays often involves aquatic recreation, frequently mixed with consumption of alcohol, both of which are risk factors for drowning. This study examines how the demographics and circumstances of public holiday drownings compare to the average day drownings. A total population survey (1 July 2002 to 30 June 2017) of unintentional fatal drownings in Australia were extracted from the Royal Life Saving National Fatal Drowning Database. Date of drowning and state/territory of residence were used to determine if the drowning occurred on a public holiday in the person’s place of residence. 4175 persons drowned during the study period. There was a statistically significant difference between the incidence of fatal drowning on public holidays and the other days, with fatal drowning 1.73 times more likely to occur on public holidays (CI: 1.57–1.89). The increased risk of drowning on public holidays should inform the timing and the content of drowning prevention campaigns and strategies.