Table 2 Included papers on unintentional female drowning epidemiology and risk factors (n=9) (Results, page 10)

Peden et al. (2016) [14]

Australia

Unintentional drowning deaths in rivers, creeks and streams

Design: Cross-sectional study

Data collection: Australian National Coronial Information System, July 2002 to June 2012.

Drowning deaths: Females n=151/770

(19.6%)

Females 2.27 times more likely to drown in rivers in non-aquatic transport, and 4.45 times more likely to drown being swept away by floodwaters.

Activity: non-aquatic transport, being swept away

Level IV-Low level evidence

GRADE-Very low

Coroner cases with open findings may overestimate number of deaths from river drownings. Some variables had limited information due to open finding.

Gulliver & Begg (2005) [41]

New Zealand

To describe water-related behaviour and non-fatal drowning incidents among young adults

Design: Cross-sectional study

Data collection: Longitudinal study, Dunedin Multidisciplinary Health and Development Study, 1993 to 1994.

Non-fatal drowning incidents:

Females n=52/141 (37%)

Females reported lower rates of water confidence, risk exposure and experience of a non-fatal drowning incident.

Females were higher risk of drowning within two hours of consuming alcohol and engaging in watercraft activity.

Water confidence, exposure, alcohol and watercraft

Level IV-Low level evidence

GRADE-Very low

Participants were asked about alcohol use and engagement in water activity, although the amount of alcohol consumption was not recorded.

Henderson & Wilson (2006) [42]

United Kingdom

To examine hospital admissions from a water-related incident.

Design: Cross-sectional study

Data collection: HES England using ICD-10 coding, 1997 to 2004.

Females n=1787/6793 (26.3%)

1 fatal drowning=3 hospital presentations.

Numbers of females increased in the ICD-10 codes for: drowning and submersion in bathtub and following fall into bathtub, and victim of flood.

Submersion in bathtub, fall into bathtub and victim of flood

Level IV-Low level evidence

GRADE-Very low

Personal and environmental factors prior to drowning incident were not captured in this study.

Hudson et al. (2006) [43]

United States

To examine factors associated with injuries occurring in drowning incidents among hospitalised patients in Alaska

Design: Cross-sectional study

Data collection: State of Alaska Department of Public Health Alaska Trauma Registry, 1991 to 2000.

Immersion only: females n=25/89 (28%)

Associated injuries:

Females n=17/87 (20%)

Females associated with increased hospitalisations from a drowning incident (p=0.02).

Females were found to be at higher risk of an associated injury than males.

High risk of injury from drowning

Level IV-Low level evidence

GRADE-Very low

The higher risk of associated injury from immersion-related event among females may be due to Alaskan males being more experienced in working and recreationally interacting with the water.

Morgan et al. (2009) [44]

Australia

To explore self-reported water exposure, activity, protective factors and drowning risk at surf beaches by gender.

Design: Prospective cross-sectional study

Data collection: Self-reported survey from December 2003 to February 2004

Females n=210/406 (51.7%)

Females visited surf beaches less than males, but length of stay was similar.

Number of males and females engaged in wave swimming were similar (females n=80, males n=88).

Exposure, risk-taking behaviour

Level IV-Low level evidence

GRADE-Very low

Sampling method may have been biased, as a person may have visited the surf beach more than once during data collection (16 days). Small sample size in sub-group for surfing (females n=14, males n=79).

Nasrullah & Muazzam (2011) [45]

United States

To describe demographics and changes in unintentional drowning mortality

Design: Cross-sectional study

Data collection: Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System mortality data. 1999 to 2006

Females n=5846/27514 (21.2%)

Increase of 9.5% of drowning fatalities for females, male drowning fatalities decreased by 0.7%.

Female drowning fatalities increased by 7% in 2004 to 2005

Fatal drowning

Level IV-Low level evidence

GRADE-Very low

There may be errors or missing data on death certificates that could lead to an incorrect classification of injury.

Peden et al. (2018) [46]

Australia

To explore river use and alcohol consumption and attitudes towards drowning risk

Design: Prospective Cross-sectional study

Data Collection: Convenience sample, survey conducted in four river locations across Australia

Females n=353/684 (51.6%)

Females visiting rivers in similar number to males but females engaging in non-aquatic activities.

Higher number of females with positive blood concentration than males

Exposure, alcohol, risk-taking behaviour

Level IV-Low level evidence

GRADE-Vey low

Possibility of recall bias due to self-reporting survey. Random convenience sampling used, and refusal rate was not documented.

Peden et al. (2018) [47]

Australia

To compare fatal and non-fatal drowning databases in Australia to identify key ratios, differences and inform drowning prevention strategies.

Design: Retrospective Cross-sectional study

Data collection: Royal Life Saving Society Australia National Fatal Drowning Database and Australian Institute of Health and Welfare National Hospital Morbidity Database, July 2002 to June 2015.

Fatalities (all ages): Females n=525/2272 (23.1%)

Hospital separations (all ages):

Females n=2088/6158 (33.9%)

Unintentional fatal drowning: Adult females n=353/1737 (20.3%)

Hospitalisations for drowning: Adult females n=687/2585 (26.6%)

Non-fatal

drowning

Level IV-Low level evidence

GRADE-Very low

An error could have occurred during in the prediction of fatal drownings, a correction factor was applied to the number of fatal drowning incidents and to predict the number of non-fatal drowning incidents. ICD coding for drowning data was limited to the codes W65-74 as primary cause of hospitalisation for non-fatal drowning incidents.

Clemens et al. (2016) [48]

Canada

To describe the characteristics of drowning fatalities by age

Design: Retrospective descriptive analysis

Data collection: Coroner’s reports, hospital data, police reports and death certificates, January 2008 to December 2012.

Females n=424/2391 (17.7%)

Drowning incidents: adult females: 20-34 years: n=73/592 (12.3%), 35-64 years: n=179/1033 (17.3%), 65 + years: n=93/419 (22.2%)

Female adult unintentional drowning deaths*: 20-34 years: (0.42), 35-64 years: (0.5), 65 + years: (0.69)

Age

Level IV-Low level evidence

GRADE-Very low

Risk of information bias due to data recorded by individual data collectors.

Some data missing