Yadav, Jeetendra, John, Denny, Menon, Geetha R., Franklin, Richard C., and Peden, Amy E. (2022) Non-fatal drowning-related hospitalizations and associated healthcare expenditure in India: An analysis of nationally representative survey data. Journal of Safety Research, 82. pp. 283-292.

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Abstract

Background: Drowning is a global public health challenge, with significant burden in low- and middle income countries. There are few studies exploring nonfatal drowning, including the economic and social impacts. This study aimed to quantify unintentional drowning-related hospitalization in India and associated healthcare expenditure. Method: Unit level data on unintentional drowning-related hospitalization were obtained from the 75th rounds of the National Sample Survey of Indian households conducted in 2018. The outcome variables were indices of health care cost such as out of pocket expenditure (OOPE), health care burden (HCB), catastrophic health expenditure (CHE), impoverishment, and hardship financing. Descriptive statistics and multivariate analysis were conducted after adjusting for inflation using the pharmaceutical price index for December 2020. The association of socio-demographic characteristics with the outcome variable was reported as relative risk with 95% CI and expenditure reported in Indian Rupees (INR) and United States dollars (USD). Results: 174 respondents reported drowning-related hospitalization (a crude rate of 15.91–31.34 hospitalizations per 100,000 population). Proportionately, more males (63.4%), persons aged 21–50 years (44.9%) and rural dwelling respondents (69.9%) were hospitalized. Drowning-related hospitalization costs on average INR25,421 ($345.11USD) per person per drowning incident. Costs were higher among older respondents, females, urban respondents, and longer lengths of hospital stays. About 14.4% of respondents reported hardship financing as a result of treatment costs and 9.0% of households reported pushed below the poverty line when reporting drowning-related hospitalization. Conclusions: Drowning can be an economically catastrophic injury, especially for those already impacted by poverty. Drowning is a significant public health problem in India. Investment in drowning prevention program will reduce hospitalization and economic burden. Practical Applications: This study provides support for investment in drowning prevention in India, including a need to ensure drowning prevention interventions address the determinants of health across the lifespan.

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