Comparing rivers to lakes: implications for drowning prevention

Objective: To contrast unintentional fatal drowning in rivers with lakes to determine appropriateness for application of existing river drowning prevention strategies. Design: A total population retrospective cross‐sectional analysis using coronial data. Setting: Australia, 1 July 2013 to 30 June 2018. Participants: Children and adults (n = 342) who died from unintentional drowning in a river or lake. Main outcome measures: Incidence, crude fatality rates, relative risk (95% confidence interval) and chi‐square tests of independence for risk factors for unintentional fatal drowning. Subset analysis of land management for lake drowning locations. Results: Four‐fifths (82%) occurred in rivers. Lake drowning was more likely among 0‐ to 17‐year‐olds, Aboriginal and Torres Strait Islander people and when swimming or using watercraft. River drowning most commonly occurred following a fall into water and with alcohol involvement. Drowning risk in very remote areas was elevated for both lakes (relative risk = 18.34; 95% confidence interval: 1.61‐209.44) and rivers (relative risk = 15.89; 95% confidence interval: 5.56‐45.37) compared to major cities. Those responsible for land and water management at lakes were primarily local government (59%), water authorities (32%) and parks and wildlife authorities (7%). Conclusions: In contrast to a focus on adults and alcohol in existing river drowning prevention strategies, lake interventions must target children, Aboriginal and Torres Strait Islander peoples and recreational lake users. Fatal drowning rates are high for remote rivers and lakes, necessitating focused effort. There are opportunities to embed drowning prevention strategies within land and water management plans. Lake drowning prevention requires broader engagement with land and water managers and Aboriginal and Torres Strait Islander peoples