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Research

The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis

Cody L. Dunne, Julia Sweet and Tessa Clemens
CMAJ May 09, 2022 194 (18) E637-E644; DOI: https://doi.org/10.1503/cmaj.211739
Cody L. Dunne
Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers’ Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont.
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Julia Sweet
Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers’ Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont.
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Tessa Clemens
Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers’ Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont.
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  • Figure 1:
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    Figure 1:

    Contribution of 5 pre-existing medical conditions to drowning deaths in Canada from 2007 to 2016, stratified by age category. Note: more than 1 pre-existing condition may have been identified as a potential contributor in a single case of drowning.

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    Figure 2:

    Relative risk of fatal drownings for people with (A) ischemic heart disease, (B) seizure disorder and (C) respiratory disease compared with the general population of Canada, stratified by age. Note: CI = confidence interval, RR = relative risk.

Tables

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    Table 1:

    Characteristics of people with and without pre-existing medical conditions who fatally drowned unintentially in Canada (2007–2016)

    CharacteristicNo. (%)* of people who drowned
    n = 4288
    No. (%)* of people with a PEMC who drowned
    n = 1412
    No. (%)* of people without a PEMC who drowned
    n = 2876
    Unadjusted RR (95% CI)Adjusted† RR (95% CI)
    Sex
     Male3450 (80.5)1069 (75.7)2381 (82.8)0.91 (0.88–0.95)0.92 (0.88–0.95)
    Age, yr
     < 5187 (4.4)9 (0.6)178 (6.2)0.27 (0.14–0.53)
     5–19452 (10.5)56 (4.0)396 (13.8)0.75 (0.56–1.01)
     20–341006 (23.5)164 (11.6)842 (29.3)Ref.
     35–641804 (42.1)646 (45.8)1158 (40.3)1.64 (1.52–1.74)
     ≥ 65839 (19.6)537 (38.0)302 (10.5)4.9 (4.4–5.4)
    Age, yr; median (IQR)44 (25–60)58 (43–71)35 (22–53)
    Location
     Rural1591 (37.1)402 (28.5)1189 (41.3)0.69 (0.62–0.76)0.70 (0.63–0.78)
    Activity
     Aquatic activity1091 (25.4)322 (22.8)769 (26.7)Ref.
     Bathing460 (10.7)336 (23.8)124 (4.3)5.6 (4.7–6.7)5.9 (4.8–7.0)
     Boating1009 (23.5)225 (15.9)784 (27.3)0.36 (0.27–0.47)1.23 (0.98–1.52)
     Nonaquatic activity909 (21.2)337 (23.9)572 (19.9)1.42 (1.26–1.60)1.45 (1.27–1.65)
     Transportation798 (18.6)182 (12.9)616 (21.4)0.83 (0.71–0.97)0.83 (0.70–0.98)
    Body of water
     Pool330 (7.7)138 (9.8)192 (6.7)Ref.
     Hot tub or whirlpool75 (1.8)40 (2.8)35 (1.2)1.59 (0.97–2.59)1.05 (0.60–1.83)
     Bathtub467 (10.9)341 (24.2)126 (4.4)3.4 (2.6–4.3)3.1 (2.3–4.2)
     Lake or pond1550 (36.1)423 (30.0)1127 (39.2)0.64 (0.53–0.77)0.59 (0.47–0.73)
     Flowing water1181 (27.5)292 (20.7)889 (31.0)0.55 (0.44–0.68)0.54 (0.42–0.69)
     Ocean356 (8.3)82 (5.8)274 (9.5)0.44 (0.32–0.60)0.34 (0.24–0.48)
    Accompaniment
     With at least 1 adult1670 (38.9)281 (19.9)1389 (48.3)Ref.
     Alone or not witnessed2126 (49.6)1024 (72.5)1102 (38.3)1.84 (1.77–1.91)1.69 (1.6–1.7)
     With bystanders only110 (2.6)42 (3.0)68 (2.4)2.75 (1.88–3.98)1.99 (1.32–2.97)
     With minors only173 (4.0)14 (1.0)159 (5.5)0.43 (0.25–0.73)0.95 (0.54–1.61)
    Alcohol use
     Present1537 (35.8)391 (27.7)1146 (39.8)0.70 (0.63–0.77)0.72 (0.65–0.80)
    • Note: CI = confidence interval, IQR = interquartile range, PEMC = pre-existing medical condition, Ref. = reference category, RR = relative risk.

    • ↵* Unless specified otherwise.

    • ↵† Adjusted only for age.

    • View popup
    Table 2:

    Characteristics of people who fatally drowned unintentionally in Canada (2007–2016), by type of pre-existing medical condition

    CharacteristicNo. (%) of people who fatally drowned*
    n = 1412
    With cardiovascular disease
    n = 759
    With respiratory disease
    n = 98
    With seizure disorder
    n = 194
    With a physical disability
    n = 230
    With neurocognitive disorder
    n = 128
    Sex
     Male604 (79.6)71 (72.4)129 (66.5)154 (67.0)95 (74.2)
    Age, yr
     < 50 (0.0)2 (2.0)3 (1.6)1 (0.43)4 (3.1)
     5–192 (0.3)5 (5.1)18 (9.3)12 (5.2)15 (11.7)
     20–3424 (3.2)7 (7.1)63 (32.5)31 (13.5)12 (9.4)
     35–64330 (43.5)40 (40.8)96 (49.5)114 (49.6)34 (26.6)
     ≥ 65403 (53.1)44 (44.9)14 (7.2)72 (31.3)63 (49.2)
    Location
     Rural241 (31.8)34 (34.7)37 (19.1)52 (22.6)24 (18.8)
    Activity
     Aquatic activity202 (26.6)21 (21.4)35 (18.0)43 (18.7)19 (14.8)
     Bathing156 (20.6)25 (25.5)98 (50.5)52 (22.6)36 (28.1)
     Boating141 (18.6)16 (16.3)12 (6.2)24 (10.4)6 (4.7)
     Nonaquatic activity163 (21.5)21 (21.4)37 (19.1)74 (32.3)48 (37.5)
     Transportation93 (12.2)14 (14.3)9 (4.6)34 (14.8)16 (12.5)
    Body of water
     Pool88 (11.6)10 (10.2)20 (10.3)20 (8.7)18 (14.1)
     Hot tub or whirlpool27 (3.6)0 (0.0)5 (2.6)8 (3.5)1 (0.8)
     Bathtub159 (20.9)25 (25.5)102 (52.6)53 (23.0)36 (28.1)
     Lake or pond274 (36.1)33 (33.7)25 (12.9)64 (27.8)24 (18.8)
     Flowing water122 (16.1)13 (13.3)19 (9.8)59 (25.7)34 (26.6)
     Ocean43 (5.7)8 (8.2)7 (3.6)11 (4.8)8 (6.3)
    Accompaniment
     With at least 1 adult163 (21.5)24 (24.5)25 (12.9)28 (12.2)10 (7.8)
     Alone or not witnessed547 (72.1)65 (66.3)151 (77.8)178 (77.4)108 (84.4)
     With bystanders only25 (3.3)1 (1.0)3 (1.6)7 (3.0)2 (1.6)
     With minors only6 (0.8)1 (1.0)7 (3.6)3 (1.3)1 (0.8)
    Alcohol use
     Present216 (28.5)29 (29.6)27 (13.9)59 (25.7)16 (12.5)
    • View popup
    Table 3:

    Relative risk of fatal drowning among people with pre-existing medical conditions in Canada (2007–2016), by age and sex

    PEMCRR (95% CI)
    People aged 1–19 yrPeople aged 20–34 yrPeople aged 35–64 yrPeople aged ≥ 65 yrAll ages
    Ischemic heart disease
     All–8.7 (5.6–14)4.0 (3.6–4.6)2.3 (2.0–2.6)2.7 (2.5–3.0)
     Male–8.8 (5.6–14)3.2 (2.8–3.6)1.8 (1.5–2.1)2.2 (2.1–2.5)
     Female–3.4 (0.48–25)5.0 (3.7–6.8)2.9 (2.2–3.7)3.8 (3.1–4.5)
    Respiratory disease
     All0.07 (0.03–0.14)0.05 (0.03–0.11)0.14 (0.10–0.19)0.13 (0.10–0.18)0.12 (0.10–0.15)
     Male0.07 (0.03–0.16)0.04 (0.02–0.11)0.14 (0.10–0.20)0.12 (0.09–0.18)0.11 (0.09–0.14)
     Female–0.11 (0.03–0.44)0.19 (0.11–0.35)0.16 (0.09–0.28)0.17 (0.11–0.24)
    Seizure disorder
     All7.0 (4.4–11)8.8 (6.7–12)6.8 (5.5–8.5)1.8 (1.0–3.2)6.3 (5.4–7.3)
     Male5.4 (3.0–9.8)6.1 (4.3–8.8)5.4 (4.2–7.1)1.3 (0.6–2.7)4.9 (4.0–5.9)
     Female12 (5.5–25)23 (14–39)13 (8.7–19)3.2 (1.3–7.7)12 (8.9–15)
    Neurocognitive disorder
     All–––1.04 (0.80–1.4)–
     Male–––1.22 (0.90–1.7)–
     Female–––1.10 (0.68–1.8)–
    • Note: CI = confidence interval, PEMC = pre-existing medical condition, RR = relative risk.

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Canadian Medical Association Journal: 194 (18)
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The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis
Cody L. Dunne, Julia Sweet, Tessa Clemens
CMAJ May 2022, 194 (18) E637-E644; DOI: 10.1503/cmaj.211739

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The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis
Cody L. Dunne, Julia Sweet, Tessa Clemens
CMAJ May 2022, 194 (18) E637-E644; DOI: 10.1503/cmaj.211739
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