Trends in unintentional drowning - The role of alcohol and medical care
Trends in unintentional drowning - The role of alcohol and medical care
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DOI：
10.1001/jama.281.23.2198
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发表时间：
1999-06-16
影响因子：
120.7
通讯作者：
Quan, L
中科院分区：
文献类型：
--
作者：
Cummings, P;Quan, L
在过去的几十年里，由于未知的原因，美国溺水死亡率有所下降。据推测，这种下降可能是由于在水中和周围使用酒精的减少或浸泡后医疗条件的改善。目的：估计因淹没而导致的意外死亡的变化，估计因饮酒而导致的溺水趋势，并评估医疗保健在这些死亡率趋势中的作用。设计一项从1975年1月1日至1995年12月31日为期21年的纵向研究。环境和参与者华盛顿州金县所有因溺水意外死亡的居民和284名因溺水而住院的幸存者。主要结局指标：随时间变化的溺水相关死亡率、可归因于酒精使用的死亡率比例、治疗患者病死率随时间变化的情况，以及1995年预防的死亡估计数与1975年以来发病率没有变化的预测估计数的比较。结果：21年间，金县有539人死于溺水。在此期间，死亡率下降了59%(95%可信区间[CI]， -70%至-46%)，酒精使用导致的死亡发生率下降了81%(95%可信区间，-91%至-57%)；这可能占1995年预防的死亡人数的51%，在249名接受院前护理的昏迷患者中，205人死亡；21年生存率下降40% （P = 0.40）。101例住院昏迷患者中，63例死亡；生存率降低29% （P = 0.75）。昏迷住院患者的生存率从1975年到1995年下降了29% （95% CI， -78%至+125%）。我们没有发现任何证据表明1995年的医疗趋势可以防止溺水死亡。结论：华盛顿金县溺水发生率下降的原因是严重溺水事件的减少，而不是医疗干预成功率的提高。我们的数据支持这样一个理论，即在水附近少喝酒可以预防一些死亡。大约一半的减少是无法解释的。
Context During the last few decades, mortality from drowning has decreased in the United States for unknown reasons. It has been hypothesized that this decline may be due to decreased use of alcohol in and around water or improved medical treatment after a submersion.Objectives To estimate changes in unintentional mortality due to submersion, estimate trends in drownings attributable to alcohol use, and assess the role of medical care in these mortality trends.Design A 21-year longitudinal study of case findings, from January 1, 1975, through December 31, 1995.Setting and Participants All residents of King County, Washington, who died unintentionally from submersion and 284 persons hospitalized for submersion who survived.Main Outcome Measures Changes in submersion-related mortality incidence over time, proportion of this mortality that could be attributed to alcohol use, changes over time in the case-fatality rate of treated patients, and estimate of deaths prevented in 1995 compared with projected estimates had there been no change in incidence since 1975,Results There were 539 deaths due to drowning in King County during 21 years. Mortality rates during this period declined by 59% (95% confidence interval [CI], -70% to -46%), The incidence of death attributable to alcohol use decreased by 81% (95% CI, -91% to -57%); this could account for 51% of deaths prevented in 1995, Among 249 comatose patients who received prehospital care, 205 died; the odds of survival decreased 40% over 21 years (P = .40). Among 101 comatose patients who were hospitalized, 63 died; the odds of survival decreased 29% (P = .75). The incidence of survival of comatose hospital patients decreased by 29% from 1975 to 1995 (95% CI, -78% to +125%). We found no evidence that trends in medical treatment prevented any deaths due to drowning in 1995.Conclusions Drowning incidence in King County, Washington, declined because of a decrease in severe submersion episodes rather than an increase in success of medical interventions. Our data support the theory that less use of alcohol around water prevents some deaths, About half of the decrease was unexplained.