The Association Between Child Opportunity Index and Severe Drowning in Children

To examine the association between socioeconomic advantage, measured by Child Opportunity Index (COI), and severe drowning outcomes.

We conducted a cross-sectional study of children aged 0-18 years old with unintentional drownings identified by diagnosis codes in the Pediatric Health Information System, 2016-2021. The composite outcome of severe drowning included invasive or noninvasive respiratory support, intensive care unit admission, cardiac arrest, poor neurologic outcome, and/or death. The primary exposure was COI, ranging from very low to very high. We performed multivariable logistic regression analysis for the outcome of severe drowning, with COI as the exposure variable while adjusting for covariates, reporting aOR and 95% CIs.

Among 4247 children with drowning, 63% were 1-4 years old and 58% were male. In multivariable analysis, greater odds of severe drowning outcomes were associated with very low (OR 1.51, 95% CI 1.07-2.15), low (OR 1.61, 95% CI 1.19-2.17), and moderate (OR 1.29, 95% CI 1.02-1.63) compared with very high COI group. There were greater odds of poor neurologic outcome in the very low (OR 2.33, 95% CI 1.43-3.81), low (OR 2.26, 95% CI 1.45-3.52), and moderate (OR 1.69, 95% CI 1.05-2.72) compared with the very high COI group.

Children in communities with lower compared with greater opportunity had worse outcomes after drowning. Focused drowning-prevention efforts for lower opportunity communities may decrease severe drowning outcomes in this population.