Burden and risk factors of premature drowning mortality in 204 countries and territories, 1980-2021.

Drowning ranks as the third leading cause of unintentional injury deaths globally. We conducted a systematic analysis of drowning mortality and its associated risk factors. Data on mortality, years of life lost (YLLs), and risk factors related to drowning (ICD-10 codes W65-74) from 204 countries and territories between 1980 and 2021 were obtained from the Global Burden of Disease 2021. Countries and territories were classified into five Socio-demographic Index (SDI) groups. The age-period-cohort (APC) model was used to estimate the effects of age, period, and cohort, along with the net drift, which reflects the annual percentage change over the study period. We additionally examined drowning mortality attributable to three risk factors: high alcohol use, high temperature, and occupational injuries. Globally, an estimated 233 906 premature deaths and 15.0 million YLLs were related to drowning in 2021, marking a 54.5% and 66.2% reduction, respectively, compared to 1980. The global age-standardised mortality rate (ASMR) also declined substantially from 11.09 per 100 000 in 1980 to 3.16 per 100 000 in 2021. Low-middle and low SDI countries exhibited the highest ASMR for drowning (3.81 and 4.47 per 100 000), nearly four times higher than high SDI countries (0.99 per 100 000). Encouragingly, certain countries like China (net drift: - 2.54%) and India (- 1.75%) demonstrated significant progress. From 1990 to 2021, the ASMR of drowning mortality attributable to high temperature or occupational injuries exhibited declining trends. Conversely, the ASMR attributable to high alcohol use showed an increasing trend in some middle, low-middle, and low SDI countries. Despite substantial reductions, drowning remains a significant contributor to premature mortality, particularly in middle, low-middle, and low SDI countries. As most premature drowning deaths are linked to preventable and modifiable risk factors, targeted strategies addressing these factors are essential to further reduce these fatalities.