Changes in drowning mortality rates and quality of reporting from 2004-2005 to 2014-2015: A comparative study of 61 countries

Background: This study assessed international variations in changes in drowning mortality rates and the quality of reporting specific information in death certificates over the past decade. Methods: Drowning mortality data of 61 countries were extracted from the World Health Organization Mortality Database. We calculated the percentage change (PC) in age-standardized drowning mortality rates and percentage of drowning deaths reported with unspecified codes between 2004 and 2005 and 2014-2015. Results: Of the 61 countries studied, 50 exhibited a reduction in drowning mortality rates from 2004 to 2005 to 2014-2015. Additionally, five countries - Lithuania, Moldova, Kyrgyzstan, Romania, and El Salvador - with a high mortality rate in 2004-2005 (> 40 deaths per 100,000) showed improvement (PC < - 32%). By contrast, four countries - South Africa, Guyana, Morocco, and Guatemala - exhibited a more than twofold increase in mortality rates. Regarding the quality of reporting, 34 countries exhibited a decrease in the percentage of unspecified codes. Additionally, three countries - Paraguay, Serbia, and Croatia - with moderate and high percentages of unspecified codes (> 40%) exhibited a marked reduction (PC < - 60%), whereas three countries - Malaysia, Belgium, and Nicaragua - exhibited a notable increase. Conclusions: Large international variations in the extent of changes in drowning mortality rates and the quality of reporting specific information on the death certificate were observed during the study period.