Risk factors for fatal drowning in a Greek region: a retrospective case–control study

Abstract

BackgroundFatal drowning is one of the leading causes of unintentional injury mortality worldwide and a persistent public health concern in Greece. While several pathologic and sociodemographic contributing factors have been previously identified, these have not been extensively investigated in conjunction with the effects of psychoactive substances.MethodsA retrospective case–control study of drowning deaths was conducted in the Greek regions of Northern Greece and Thessaly during a 10-year period. A regression model was constructed examining differences in detected substances, autopsy findings and sociodemographic characteristics between 240 victims of unintentional fatal submersion and 480 victims of other causes of sudden or violent death.ResultsThe majority of victims were males (69.4%) and foreign nationality was associated with increased odds of drowning. Cardiomegaly and coronary bypass grafts were significantly more likely to have been recorded among drowning victims, while the frequency of other circulatory system disorders was also elevated. Several of these findings were potential arrhythmogenic substrates which could adversely interact with the diving reflex. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly detected pharmacological group (9.0%), and along with tramadol, there was an increased likelihood of exposure to them. These drugs have been previously associated with QT prolongation and other adverse effects which may contribute to fatal outcomes in a seawater environment. In contrast, there was a decreased risk of exposure to dependence-inducing drugs and paracetamol.ConclusionsMale sex, older age, foreign nationality and cardiovascular disease predisposed individuals to an elevated risk of fatal submersion. SSRI antidepressants and tramadol may contribute to this outcome.

Pre-Existing Medical Conditions: A Systematic Literature Review of a Silent Contributor to Adult Drowning

“…Ischaemic heart disease was identified in five included studies [ 53 , 55 , 85 , 89 , 90 ]. Two studies were from Greece, finding that ischaemic heart disease was present in 87.9% [ 85 ] and 51.8% of drowning deaths, respectively [ 89 ].…”

“…Ischaemic heart disease was identified in five included studies [ 53 , 55 , 85 , 89 , 90 ]. Two studies were from Greece, finding that ischaemic heart disease was present in 87.9% [ 85 ] and 51.8% of drowning deaths, respectively [ 89 ]. Two other studies reporting bath-related deaths found that ischaemic heart disease was present in 34.2% of bath-related deaths in Japan [ 53 ] and 73.7% in South Korea [ 55 ].…”

“…Among other circulatory system conditions, hypertensive heart disease was present in 66.7% of drowning deaths among those competing in triathlons in the USA [ 83 , 84 ], and atherosclerosis was found in 20% of those who drowned with a pre-existing medical condition in Greece [ 85 ] ( Table 6 ).…”

“…Given ischaemic heart disease remains a leading cause of mortality globally [ 110 ], it is unsurprising to see cardiac conditions well represented within the drowning literature. Similarly, physical exercise such as swimming can temporarily increase the risk of aggravating cardiovascular conditions [ 85 ]. This is an important challenge, as aquatic exercise can be an effective and low-impact form of exercise, thus improving health and fitness [ 111 ].…”

Current state and prospects of forensic-medical diagnosis of drowning: A review of the literature

“…Certain types of human activities and the territory of their residence (Carvalho, Kennedy, Woodroffe, 2019), migration processes (Pavlidis, Karakasi, 2019), festive periods such as public holidays (Saunders, Adriaanse, Simons, Niekerk, 2018) have an impact on increasing the number of cases of drowning. Male sex, older age, foreign nationality, and cardiovascular disease predisposed individuals to an elevated risk of fatal submersion (Kevrekidis et al, 2020).…”