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.
CMAJ. 2022 May 9;194(18):E637-E644. doi: 10.1503/cmaj.211739.
Drowning accounts for hundreds of preventable deaths in Canada every year, but the impact of preexisting medical conditions on the likelihood of death from drowning is not known. We aimed to describe the prevalence of pre-existing medical conditions among people who fatally drowned in Canada and evaluate the risk of fatal drowning among people with common pre-existing medical conditions.
We reviewed all Canadian unintentional fatal drownings (2007-2016) in the Drowning Prevention Research Centre Canada's database. For each fatal drowning we established whether the person had pre-existing medical conditions and whether those conditions contributed to the drowning. We calculated relative risk (RR) of fatal drowning stratified by age and sex for each pre-existing medical condition using data from the Canadian Chronic Disease Surveillance System.
During 2007-2016, 4288 people fatally drowned unintentially in Canada, of whom one-third had a pre-existing medical condition. A pre-existing medical condition contributed to drowning in 43.6% ( = 616) of cases. Fatal drowning occurred more frequently in people with ischemic heart disease (RR 2.7, 95% confidence interval [CI] 2.5-3.0) and seizure disorders (RR 6.3, 95% CI 5.4-7.3) but less frequently in people with respiratory disease (RR 0.12, 95% CI 0.10-0.15). Females aged 20-34 years with a seizure disorder had a 23 times greater risk than their age- and sex-matched cohort (RR 23, 95% CI 14-39). In general, fatal drowning occurred more often while people were bathing (RR 5.9, 95% CI 4.8-7.0) or alone (RR 1.99, 95% CI 1.32-2.97) and less often in males (RR 0.92, 95% CI 0.88-0.95) or in those who had used alcohol (RR 0.72, 95% CI 0.65-0.80), among those with pre-existing medical conditions.
The risk of fatal drowning is increased in the presence of some preexisting medical conditions. Tailored interventions aimed at preventing drowning based on pre-existing medical conditions and age are needed. Initial prevention strategies should focus on seizure disorders and bathtub drownings.
在加拿大，每年有数百人因溺水而死亡，这些死亡本可预防，但目前尚不清楚先前存在的医疗状况对溺水死亡的可能性有何影响。本研究旨在描述在加拿大溺水死亡者中先前存在的医疗状况的流行情况，并评估常见先前存在的医疗状况者发生致命溺水的风险。
我们对加拿大溺水预防研究中心数据库中 2007 年至 2016 年所有加拿大非故意伤害性溺水死亡事件进行了回顾。对于每例致命溺水事件，我们确定其是否存在先前存在的医疗状况，以及这些状况是否促成了溺水。我们使用加拿大慢性病监测系统的数据，按年龄和性别对每种先前存在的医疗状况进行分层，计算致命溺水的相对风险（RR）。
在 2007 年至 2016 年期间，加拿大有 4288 人非故意伤害性溺水死亡，其中三分之一的人有先前存在的医疗状况。在 616 例（43.6%）病例中，先前存在的医疗状况促成了溺水。患有缺血性心脏病（RR 2.7，95%置信区间[CI] 2.5-3.0）和癫痫发作障碍（RR 6.3，95%CI 5.4-7.3）的人更频繁地发生致命溺水，而患有呼吸疾病的人则较少（RR 0.12，95%CI 0.10-0.15）。患有癫痫发作障碍且年龄在 20-34 岁的女性发生致命溺水的风险比年龄和性别相匹配的队列高 23 倍（RR 23，95%CI 14-39）。一般而言，在洗澡时（RR 5.9，95%CI 4.8-7.0）或独处时（RR 1.99，95%CI 1.32-2.97）发生致命溺水的情况更常见，而男性（RR 0.92，95%CI 0.88-0.95）或饮酒者（RR 0.72，95%CI 0.65-0.80）发生致命溺水的情况较少。
某些先前存在的医疗状况会增加致命溺水的风险。需要根据先前存在的医疗状况和年龄制定专门的预防溺水干预措施。初始预防策略应重点关注癫痫发作障碍和浴缸溺水。
