Patterns and determinants of intentional and unintentional drowning mortality in Michigan: 2006–2024

INTRODUCTION: Drowning is the third leading cause of injury-related death worldwide but remains understudied, particularly in the Great Lakes region of North America. This research examines the epidemiology of unintentional and intentional drowning deaths using municipal records from Michigan, a temperate region of the USA. METHODS: We analysed municipal death records from 2006 to 2024 using the International Classification of Diseases, 10th Revision drowning code (T75.X) and injury-specific fields. We produced descriptive summaries of sex, race, age and location for unintentional and intentional deaths and compared population-adjusted mortality rates across demographic groups. To assess social and environmental determinants, we tested for associations between drowning mortality and US Census-based indicators as well as climate data using regression methods. RESULTS: There were N=3041 deaths. Most unintentional and intentional drowning deaths occurred among whites (75.5 %) and men (74.5 %). Age/population adjusted estimates showed substantially higher drowning mortality among black males between 15-44 compared with white males. Females were at higher risk for intentional drowning mortality, including homicide. Increased social disadvantage (relative risk (RR) 1.185 (95% CI 1.141 to 1.229)) and percent black population (RR 1.813 (95% CI 1.624 to 2.003)) were positively associated with drowning mortality. Sustained freezing temperatures for 2 weeks were associated with reduced winter drowning risk. CONCLUSIONS: Drowning mortality displays pronounced sex, racial and social disparities. Prevention should extend beyond education and safety efforts to address broader social and mental health factors that shape both unintentional and intentional drowning risk.