Association between drowning and urbanization, in Taiwan 1980-2010

Background: Globally, approximately 388,000 people died from drowning in 2004; out of this total, 96% of fatalities occurred in low-and middle- income countries (LMICs). While drowning occurrences in a majority of industrialized countries have significantly declined over the last few decades, unintentional drowning remains a leading cause of injury-related deaths, especially in LMICs. An examination of urbanization and other macro-societal changes may provide better understanding to further prevent this global public health burden.;Research Objectives: This study has two objectives: 1) to explore the association between urbanization and drowning in Taiwan and 2) to examine the impact of other major socioeconomic factors and swimming education on drowning.;Methods: A time-series panel analytic approach was used to assess the association between urbanization and drowning mortality in 21 jurisdictions in Taiwan between 1980 and 2010. Several other methods such as difference-in-differences (DID) were used to examine the impact of various drowning risk factors.;Results: The percentage of the workforce in agriculture was positively associated with male drowning rates (p<0.05 in random effects, multivariate panel regression analysis). The relationship remained significant after controlling for macro-level factors (i.e., higher education, disposal income, total physicians per ten thousand population, and poverty rate) and other urbanization-related factors of drowning (i.e., population density and industrial workforce). A 10% decrease in the agricultural workforce led to 1.7 units, (i.e., 1.7 deaths per 100,000 people) of decline in the male drowning rate. This explained approximately one-fifth of the overall drowning decline in Taiwan and up to half of the decline in counties where the agricultural workforce has declined significantly.;Significance/Contribution to the Field: The significance of this study lies in providing evidence that supports the protective effect of urbanization against drowning. It explains a common global phenomenon -the urban-rural disparity in drowning- which is favorable for urban residents in terms of preventing drowning incidents. Urbanization has served as an underlying social force in the decline of drowning over the last few decades in Taiwan before any deliberate intervention was promoted.