US Pediatric Drowning Trends: A System Dynamics Scoping Model Based on Global Burden of Disease (GBD) Estimates

Background Pediatric drowning remains a leading cause of unintentional injury death globally. Current prevention research primarily focuses on single interventions, often failing to account for the complex interactions and feedback mechanisms that drive population trends. This study demonstrates the utility of system dynamics (SD) modeling as a scoping tool to construct and test causal feedback hypotheses. Methods A scoping model was developed to simulate the drivers of pediatric drowning epidemiology. Modeling was based on historical drowning morbidity and mortality estimates of one US state from the Global Burden of Disease (GBD) initiative (1990 to 2021), supplemented by secondary literature. The model structure explicitly mapped key feedback loops, including hypothesized intergenerational transfer of swimming competency and the effect of risk perception on water supervision and prevention spending. Results The model successfully replicated the non-constant decline in pediatric drowning deaths observed in the state-specific GBD data: 50.6 per 100,000 in 1990 versus 25.7 per 100,000 in 2021. Analyses identified the causal feedback loop of Reduced Risk Perception as a dominant structure. This loop showed that over the observed period, successful prevention (e.g., improved water competency) can inadvertently lead to lower perceived risk over time, reducing resource allocation, and slowing the overall rate of mortality decline. Conclusion This study demonstrates that SD modeling is a powerful and accessible tool for testing aggregate, long-term hypotheses regarding unintentional drowning trends. It provides a framework for designing integrated, dynamic prevention strategies that account for the system tendency to adapt and introduce counter-intuitive outcomes.