Unintentional drowning in Finland 1970-2000: a population-based study.

BACKGROUND: While standard data on drowning reported by the World Health Organization (WHO) fails to provide a reliable picture of the burden of drowning in Finland, they suggest that the rates are much higher than those of other industrialized countries. AIM: To determine the true burden of drowning in Finland and factors related to its high rates. DESIGN: Descriptive, retrospective, population-based analysis of all deaths by drowning, among residents of all ages. SETTING: Finland, 1970-2000. MATERIAL AND METHODS: Mortality and population data furnished by Statistics Finland (SF) were used to determine age- and sex-specific drowning mortality rates using both nature- and cause-of-injury codes. Individual-level data from the death certificates were analysed and cross-linked to a nationwide postmortem toxicology database. RESULTS: From 1970 to 2000, 9279 unintentional drownings occurred (mean: 299.3/year SD 84.3, rate 6.1/100 000/year; M:F ratio = 8.6:1), accounting for 11.7% of all unintentional injury deaths. Drowning rates overall have decreased from 9.9/100 000/year in 1970-1972, to 4.5 in 1998-2000 (-2.7%/year; 95% CL: -3.0; -2.5). The most frequent activities related to drowning included boating (29.8%), falling (26.1%), swimming (25.0%), and activities on ice (12.4%). In non-boating-related drownings, 74.5% of males and 67.4% of females tested had a blood alcohol concentration (BAC) >/=50 mg/dl, while in boating-related drownings, the respective values were 78.1% and 71.4%. CONCLUSIONS: WHO statistics underestimate the true burden of drowning in Finland by up to 40-50%. Drowning rates and alcohol involvement in drowning are much higher than in other comparable developed countries. Broad-based countermeasures to reduce alcohol use in water activities are needed as part of any strategy to reduce drowning rates.