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Using a retrospective cross-sectional study to analyse unintentional fatal drowning in Australia: ICD-10 coding-based methodologies verses actual deaths
  1. Amy E Peden1,2,
  2. Richard C Franklin1,2,
  3. Alison J Mahony1,
  4. Justin Scarr1,
  5. Paul D Barnsley1
  1. 1 Royal Life Saving Society - Australia, Broadway, Australia
  2. 2 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
  1. Correspondence to Amy E Peden; apeden{at}


Objectives Fatal drowning estimates using a single underlying cause of death (UCoD) may under-represent the number of drowning deaths. This study explores how data vary by International Classification of Diseases (ICD)-10 coding combinations and the use of multiple underlying causes of death using a national register of drowning deaths.

Design An analysis of ICD-10 external cause codes of unintentional drowning deaths for the period 2007–2011 as extracted from an Australian total population unintentional drowning database developed by Royal Life Saving Society—Australia (the Database). The study analysed results against three reporting methodologies: primary drowning codes (W65-74), drowning-related codes, plus cases where drowning was identified but not the UCoD.

Setting Australia, 2007–2011.

Participants Unintentional fatal drowning cases.

Results The Database recorded 1428 drowning deaths. 866 (60.6%) had an UCoD of W65-74 (accidental drowning), 249 (17.2%) cases had an UCoD of either T75.1 (0.2%), V90 (5.5%), V92 (3.5%), X38 (2.4%) or Y21 (5.9%) and 53 (3.7%) lacked ICD coding. Children (aged 0–17 years) were closely aligned (73.9%); however, watercraft (29.2%) and non-aquatic transport (13.0%) were not. When the UCoD and all subsequent causes are used, 67.2% of cases include W65-74 codes. 91.6% of all cases had a drowning code (T75.1, V90, V92, W65-74, X38 and Y21) at any level.

Conclusion Defining drowning with the codes W65-74 and using only the UCoD captures 61% of all drowning deaths in Australia. This is unevenly distributed with adults, watercraft and non-aquatic transport-related drowning deaths under-represented. Using a wider inclusion of ICD codes, which are drowning-related and multiple causes of death minimises this under-representation. A narrow approach to counting drowning deaths will negatively impact the design of policy, advocacy and programme planning for prevention.

  • epidemiology
  • public health
  • drowning
  • global burden of disease
  • international classification of diseases (ICD)
  • methodology
  • injury

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors AEP, RCF and JS conceptualised the study. AEP and RCF gathered the fatality data in the Database. AJM coded the data to ICD-10, critically revised the manuscript and approved the manuscript as submitted. AEP conducted the analysis. AEP and RCF drafted the manuscript and approved as submitted. PDB and JS provided some interpretation of the data, revised it critically and approved the manuscript as submitted.

  • Competing interests AEP, RCF and AJM were responsible for collating data in the database from the Australian National Coronial Information System (NCIS).

  • Ethics approval Victorian Department of Justice and Regulation Human Research Ethics Committee (CF/07/13729; CF/10/25057, CF/13/19798).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement With respect to the minimum dataset underlying this research, these data are available on request; however, as the data are via a third party (coronial data), ethical approval and permission from the data custodians, the Australian National Coronial Information System (NCIS) is required before the authors are able to provide their dataset to the person inquiring. There are strict ethical restrictions around use of these data and it can therefore not be sent to a public repository. Once ethical approval and permission from the NCIS as data custodians has been achieved, researchers can contact to gain access to the data.

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