PC2132: Childhood Drowning Prevention: Progress Stalled

Background: Drowning is the leading cause of unintentional injury-related death among children 1-4 years of age in the U.S. and California and the second leading cause of unintentional injury-related death among California children 5-9 years of age. California is one of four states that addresses prevention of residential pool drowning through state legislation — SB 442, 2017 Pool Safety Act. The purpose of this study was to 1) determine trend data before and after passage of the law and 2) determine incident locations and age groups most at risk for fatality.

Methods: Data was abstracted from EpiCenter, designed by Safe and Active Communities Branch and constructed by Information Technology Services Division, California Department of Public Health. It is the most comprehensive source of California injury data and includes all types of injuries that result in death, hospitalization, or an emergency department visit. Overall fatal drowning rates were reviewed for children 0-17 year-olds and 1-4 year-olds using the following ICD10 External cause of morbidity Unintentional (Accidental) Drowning Codes: W65, W67, W68, W69, W70 , W73, W74. Then we used the specific location codes for the years 2018-2020 to further analyze where these fatal drownings occurred and the specific codes W67 and W68 for swimming pools. Location by age was also determined for the years 2018-2020.

Results: The overall rate of fatal drownings for 0-17 year-olds from 2010-2020 was 0.8/100,000. In contrast, the overall rate for 1-4 year-olds during this same time period was 2.3/100,000. Table 1 trend data demonstrates a decrease in overall drowning death rates for 1-4 year olds until 2016 and for pool drownings until 2017. However, these rates then increased for both overall and swimming pools. Location and age group data for 3 years (2018-2020) after the law was in effect, revealed that the most common location (70%) was a swimming pool, and of these 76% were 1-4 year-olds.

Conclusion: Despite recent changes in state law intended to reduce childhood drownings, we have seen an increase in fatal pool drownings of children 1-4 years (2018-2020). This database is excellent for trend analysis and for general location of the incident. However, it does not provide sufficient data to understand why childhood swimming pool drownings are increasing in California. The American Academy of Pediatrics strongly recommends that states establish systematic reporting on the circumstances of drowning in order to develop best practices, community interventions, and relevant public policies. Two California bills have been introduced to 1) establish a childhood fatal drowning data collection system and 2) reactivate our defunded Child Death Review Council. If passed, we anticipate analysis of swimming pool drownings which will contribute vital information that will inform on prevention strategies.