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Objective To identify the long-term patterns of drowning mortality in the state of Victoria, Australia, and to describe the historical context in which the decrease occurred. Methods We obtained data on drowning deaths and population statistics from the Australian Bureau of Statistics and its predecessors for the period 1861 to 2000. From these data, we calculated drowning death rates per 100 000 population per year, by gender and age. We reviewed primary and secondary historical resources, such as government and newspaper archives, books and the Internet, to identify changes or events in the state that may have affected drowning mortality. Findings From 1861 to 2000, at least 18 070 people drowned in Victoria. Male drowning rates were higher than those for females in all years and for all ages. Both sexes experienced the highest drowning rate in 1863 (79.5 male deaths per 100 000 population and 18.8 female death per 100 000 population). The lowest drowning rate was documented in 2000 (1.4 male deaths per 100 000 population and 0.3 female deaths per 100 000 population). The reduction patterns of drowning mortality occurred within a historical context of factors that directly affected drowning mortality, such as the improvement in people's water safety skills, or those that incidentally affected drowning mortality, like infrastructure development. Conclusion We identified patterns of reduction in drowning mortality, both in males and females and across age groups. These patterns could be linked to events and factors that happened in Victoria during this period. These findings may have relevance to current developing communities.

Motor vehicle exhaust gas suicide (MVEGS) is the second most frequent method of suicide in Victoria, Australia. It is a highly lethal method of suicide with 1.5 deaths for every hospital admission. Australian regulations require all vehicles manufactured since 1998 to have a maximum carbon monoxide exhaust emission level of 2.1 g/km, reduced from the previous level of 9.6 g/km. Information surrounding all Victorian MVEGS between 1998-2002 was analyzed to determine whether suicides occurred in vehicles with the lower emission levels. Between 1998-2002, 607 suicides by this means were recorded while just 393 hospital admissions were recorded for the same period. Mean carboxyhaemoglobin levels were significantly lower in fatalities using vehicles manufactured from 1998, however suicide still occurred in these vehicles (n = 25). The extent to which the new regulations contributed to the relatively low rate of suicide in vehicles less than 5 years old compared to their frequency in the fleet remains unknown. Based on international experience and the age of the Victorian vehicle fleet, it may take well over a decade until substantial decreases in MVEGS are observed in the absence of active preventive measures.

Availability of ICD-10 cause of death codes in the National Coroners Information System (NCIS) strengthens its value as a public health surveillance tool. This study quantified the completeness of external cause ICD-10 codes in the NCIS for Victorian deaths (as assigned by the Australian Bureau of Statistics (ABS) in the yearly Cause of Death data). It also examined the concordance between external cause ICD-10 codes contained in the NCIS and a re-code of the same deaths conducted by an independent coder. Of 7,400 NCIS external cause deaths included in this study, 961 (13.0%) did not contain an ABS assigned ICD-10 code and 225 (3.0%) contained only a natural cause code. Where an ABS assigned external cause ICD-10 code was present ( n=6,214), 4,397 (70.8%) matched exactly with the independently assigned ICD-10 code. Coding disparity primarily related to differences in assignment of intent and specificity. However, in a small number of deaths ( n=49, 0.8%) there was coding disparity for both intent and external cause category. NCIS users should be aware of the limitations of relying only on ICD-10 codes contained within the NCIS for deaths prior to 2007 and consider using these in combination with the other NCIS data fields and code sets to ensure optimum case identification.