Special Report from the CDC: The association between social vulnerability and unintentional fatal drowning in the United States, 1999–2023

Abstract

Introduction: Drowning is a major public health problem. There are about 4,500 fatal unintentional drownings in the United States each year, and more children ages 1–4 die from drowning than from any other cause. Some sociodemographic characteristics are associated with increased risk of unintentional fatal drowning. The purpose of this study was to better understand the association between county-level social vulnerability and unintentional fatal drowning. Methods: This study used the 2014 Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry’s (CDC/ATSDR) Social Vulnerability Index (SVI) and mortality data from the National Vital Statistics System from 1999 to 2023. Counties were ranked and categorized into tertiles across social vulnerability scores for all indicators of the SVI. Negative binomial regression was used to estimate crude rate ratios (RR) and 95% confidence intervals comparing county-level fatal drowning rates and the SVI indicators. Results: County-level social vulnerability is associated with unintentional fatal drowning. Counties with high overall social vulnerability had fatal drowning rates 1.59 times as high as counties with low social vulnerability. These associations were most pronounced for the SVI indicators of socioeconomic status (RR = 1.56), disability status (RR = 1.49), and proportion of mobile homes (RR = 1.62). Conclusions: While the reasons for the associations between indicators of the SVI and higher rates of drowning are not fully understood, counties with high social vulnerability may be associated with reduced access to swimming pools, affordable swimming lessons, and other evidence-based drowning prevention strategies. Practical Applications: Communities can use the SVI and other indicators of risk to support drowning prevention program implementation, ensuring strategies reach and are tailored to populations most at risk of drowning.