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Estimating the Burden
 

Estimating the Burden

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Plenary: Estimating the Burden - Nonfatal and Fatal Drowning in Recreational Water Sites - US 2001-2002

Plenary: Estimating the Burden - Nonfatal and Fatal Drowning in Recreational Water Sites - US 2001-2002

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Estimating the Burden Estimating the Burden Presentation Transcript

  • Fatal and Nonfatal Drownings at Recreational Water Sites, U.S. Julie Gilchrist MD National Center for Injury Prevention and Control Centers for Disease Control and Prevention September, 2007
  • Drowning Defined
    • Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid
    • Outcomes: fatal and nonfatal
    • In line with other injury causes
    A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ . 2005, vol. 83, no. 11. Available from: <http://www.scielosp.org/scielo.php?script=sci_arttext&pid= S0042-96862005001100015&lng=en&nrm=iso>. ISSN 0042-9686.
  • Drowning: the Problem
    • 2 nd leading cause of injury death in children 1-14 years
    • 7 th leading cause of unintentional injury deaths in all ages
    • One year of injuries in the US result in a total lifetime cost of $5.3 Billion*
    * Source : The Incidence and Economic Burden of Injuries in the United States. Oxford University Press 2006.
  • Fatal Drowning Data
    • National Vital Statistics System
    • Death Certificate data
    • Codes:
      • Swimming pool (W67-W68)
      • Natural water (W69-W70)
      • Other/Unspecified (W73, W74)
      • Boating related (V90, V92)
  • Nonfatal Drowning Data
    • National Electronic Injury Surveillance System – All Injury Project
    • Sample of US hospital emergency depts.
    • Reviewed cases: “drown” or “submersion” in cause, diagnosis or comment field
    • Excluded bathtub, toilet, bucket, motor vehicle crash
    • Numbers are weighted estimates
  • Drowning Surveillance: the Problem
    • Rates vary by age, location, gender, and race/ethnicity
    • Data systems often lack these details
    • Current rates are population based rather than based on exposures
  • Drowning * by Age *in recreational water settings Nonfatal Fatal Age (yrs) Estimate Percent Rate (95% CI) Number Percent Rate (95% CI) 0-4 2168 52.0 11.13 (3.56, 18.69) 442 13.1 2.28 (2.07, 2.50) 5-14 1058 25.3 2.58 (1.13, 4.02) 333 9.9 0.81 (0.72, 0.90) >=15 948 22.7 0.42 (0.20, 0.64) 2563 76.0 1.14 (1.10, 1.18) Unknown 34 1.0 TOTAL 4174 100.0 1.46 (0.77, 2.14) 3372 100.0 1.18 (1.14, 1.22) Data sources: National Electronic Injury Surveillance System All Injury Program for nonfatal injuries (2001-2002); National Vital Statistics System, National Center for Health Statistics for fatalities (2001).
  • Fatal Drowning Rates by Age, 2001 Fatal drowning data from National Vital Statistics System
  • Drowning by Sex *in recreational water settings Nonfatal Fatal Sex Estimate Percent Rate (95% CI) Number Percent Rate (95% CI) Male 2721 65.2 1.93 (1.16, 2.70) 2789 82.7 1.99 (1.92, 2.06) Female 1452 34.8 1.00 (0.27, 1.72) 583 17.3 0.40 (0.37, 0.43) Data sources: National Electronic Injury Surveillance System All Injury Program for nonfatal injuries (2001-2002); National Vital Statistics System, National Center for Health Statistics for fatalities (2001).
  • Fatal Drownings by Sex, 1999-2004 Fatal drowning data from National Vital Statistics System
  • Drowning by Location *in recreational water settings Nonfatal Fatal Location Estimate Percent Rate (95% CI) Number Percent Rate (95% CI) Pool 2751 65.9 0.96 (0.40, 1.51) 596 17.7 0.21 (0.19, 0.23) Natural water 909 21.8 0.32 (0.14, 0.49) 1467 43.5 0.51 (0.49, 0.54) Unspecified 513 12.3 1309 38.8 Data sources: National Electronic Injury Surveillance System All Injury Program for nonfatal injuries (2001-2002); National Vital Statistics System, National Center for Health Statistics for fatalities (2001).
  • Fatal Drowning Rates by Age Group & Location, 2001 Fatal drowning data from National Vital Statistics System
  • Pool Drowning Rates by Age Group & Race, 1999-2004 (rate per 100,000) Fatal drowning data from National Vital Statistics System
  • Natural Water Drowning Rates by Age Group & Race, 1999-2004 Fatal drowning data from National Vital Statistics System
  • Characteristics of Drowning
    • Commonly occur:
      • Weekends: Friday-Sunday: 56% of nonfatal
      • Summer: Jun-Aug: 56% of nonfatal, 51% of fatal
    *in recreational water settings
  • Drowning: Location by Age *in recreational water settings
  • Nonfatal Drowning by Disposition *in recreational water settings Nonfatal Disposition Estimate Percent Rate (95% CI) Treated and Released 1925 46.1 0.67 (0.29, 1.05) Hospitalized or Transferred 2233 53.5 0.78 (0.44, 1.12) Other/Unknown 16 0.4 -- Data source: National Electronic Injury Surveillance System All Injury Program for nonfatal injuries (2001-2002)
  • Injury Pyramid Death Hospitalization Emergency Department Outpatient Elsewhere or untreated All Unintentional Injuries Drowning 112,012 1,640,370 25,516,364 58,381,000 ? 3372 2212 1962 ~0 ~0
  • Summary
    • Leading cause of injury death
    • Small children at greatest risk – pools
    • Men at higher risk than women
      • Choices of activities
      • Increased use of alcohol
    • Severe nature of injury
      • Dramatic hospitalization rate
      • Inverted injury pyramid
  • Importance of Prevention
    • Advanced in-hospital care does not improve outcomes
    • Half of victims in ED are hospitalized
    • Severe, disabling injuries
  • Prevention of Drowning
    • Primary prevention: prevent water entry
      • Four sided isolation pool fencing
      • Other adjunctive barriers
  • Prevention of Drowning
    • Secondary prevention: prevent harm
      • Personal Flotation Devices
      • Avoiding alcohol use
      • Improve swimming ability
      • Water safety training (e.g. rip currents)
      • Lake front slope gradients
  • Improving Swimming Ability
    • Creating opportunities
      • Access to appropriate supervised aquatic environments
      • Access to training/lessons
  • Improving Swimming Ability
    • Increasing participation
      • Desirability compared to other activities
      • Understanding that it is a life-saving skill
      • Role models
  • Prevention of Drowning
    • Tertiary prevention: improve outcomes
      • Lifeguards
      • Bystander CPR
      • Rapid Emergency Service Response
  • Resources
    • CDC’s Injury Center www.cdc.gov/injury
    • WONDER wonder.cdc.gov
    • WISQARS www.cdc.gov/ncipc/wisqars
  • WONDER vs. WISQARS
    • WONDER: county level data, specific codes;
    • but only by standard age groups
    • WISQARS: specific year of age or non-standard age groups;
    • but no county level or specific codes
  • Thanks Julie Gilchrist, MD [email_address]