The global decline in drowning burden
Over the past three decades, significant progress has been made in reducing the global burden of unintentional drowning. Data from the Global Burden of Disease (GBD) Study 2019 reveal a marked decline in the age-standardized mortality rate and disability-adjusted life-years (DALYs) rate of unintentional drowning worldwide.
Globally, the age-standardized mortality rate decreased by 61.5% from 8.1 per 100,000 in 1990 to 3.1 per 100,000 in 2019. Similarly, the DALYs rate dropped by 68.2% from 553 per 100,000 in 1990 to 175.9 per 100,000 in 2019. This substantial reduction in the burden of drowning is a significant public health achievement.
Unintentional drowning burden in China
China, as the most populous country in the world, has also experienced a notable decline in unintentional drowning over the past three decades. According to the GBD 2019 data, China’s age-standardized mortality rate for unintentional drowning decreased by 68.6%, from 8.5 per 100,000 in 1990 to 2.7 per 100,000 in 2019. The DALYs rate also saw a substantial reduction of 74.9%, from 580.6 per 100,000 in 1990 to 145.4 per 100,000 in 2019.
The decline in drowning burden in China was observed across different age groups and genders. Children under the age of 5 witnessed the most significant reduction, with an 81.1% decrease in both mortality and DALYs rates. Older adults aged 70 and above also experienced a substantial decline, though the burden remained higher compared to other age groups.
Regarding gender, the reduction in drowning burden was slightly higher for women compared to men. The age-standardized mortality rate decreased by 66.6% for women and 58.8% for men, while the DALYs rate declined by 73.5% for women and 65.3% for men.
Regional and provincial variations in China
Within China, the burden of unintentional drowning exhibited substantial regional variations. The provinces in the Western Pacific and South-East Asia regions generally experienced the most significant declines, with reductions in age-standardized mortality rates of 65.0% and 61.3%, respectively.
At the provincial level, some areas in China witnessed remarkable progress, while others saw a concerning increase in drowning burden. For instance, the provinces of Guangdong, Sichuan, and Henan achieved substantial reductions in both mortality and DALYs rates, with decreases exceeding 70%. In contrast, a few provinces, such as Guizhou and Hainan, experienced increases in drowning burden during the study period.
The role of social determinants of health
The observed decline in the global and Chinese burden of unintentional drowning can be largely attributed to improvements in social determinants of health (SDH). Using a weighted quartile sum (WQS) regression analysis, the current study found that every one-percentile increase in six key SDH factors was associated with a 0.15% and 0.16% decrease in age-standardized mortality and DALYs rates, respectively.
The SDH factors that had the most significant impact on reducing the global burden of drowning were:
- Health spending: Accounting for 53% of the reduction in mortality rate and 55% of the reduction in DALYs rate.
- Gross Domestic Product (GDP) per capita: Contributing 24% and 21% to the decrease in mortality and DALYs rates, respectively.
- Health workers: Responsible for 20% and 18% of the reductions in mortality and DALYs rates.
When analyzing the results by economic development level, the impact of SDH was more pronounced in low-income and lower-middle-income countries. In these settings, the improvement in SDH factors, such as GDP per capita, health spending, and educational attainment, played a more significant role in driving the decline in drowning burden.
Implications for drowning prevention in China
The remarkable progress in reducing the burden of unintentional drowning in China over the past three decades is commendable. However, the regional and provincial variations, as well as the persistent higher burden among certain age groups and genders, highlight the need for targeted interventions and policies.
To further drive down the drowning burden in China, a multifaceted approach addressing the underlying social determinants of health is crucial. Investments in improving economic conditions, strengthening healthcare systems, enhancing educational attainment, and promoting urbanization can contribute significantly to the prevention and control of drowning.
Moreover, the development of localized water safety plans that consider the specific drowning burden and environmental risk factors in each province or region can help tailor interventions to address the unique challenges faced by different communities. Collaboration between government agencies, public health organizations, and community stakeholders will be essential in implementing these targeted strategies.
By addressing the social determinants of health and implementing evidence-based, context-specific interventions, China can continue to make strides in reducing the burden of unintentional drowning and ensure a safer aquatic environment for its population.
Conclusion
The global and Chinese burden of unintentional drowning has declined significantly over the past three decades, with notable reductions in age-standardized mortality and DALYs rates. This progress can be largely attributed to improvements in social determinants of health, particularly in areas of health spending, GDP per capita, and health worker availability.
However, regional and provincial variations within China, as well as the persistently higher burden among certain age groups and genders, underscore the need for continued efforts in drowning prevention. Addressing the underlying social determinants of health through targeted interventions and policies will be crucial in driving further reductions in the burden of unintentional drowning in China and ensuring equitable access to water safety for all.
By leveraging the insights from this comprehensive analysis, policymakers, public health professionals, and community stakeholders can collaborate to develop and implement tailored strategies that address the specific drowning challenges faced by different regions and populations in China. Through these concerted efforts, the country can continue its progress in safeguarding lives and promoting water safety for its citizens.
