Recent trends in fatal unintentional drowning rates in the United States, 1999–2020

•Overall fatal unintentional drowning rates have stabilized from 2014 to 2020.•Recent trends have declined among Non-Hispanic Whites, Asians/Pacific Islanders, and American Indians/Alaska Natives.•Recent trends have stabilized among Non-Hispanic Blacks and Hispanics.•Trends have been declining among males since 1999 but have been stable among females since 2015.•Trends have been declining across all US census regions since 1999. Background: This study aimed to examine the trends in fatal unintentional drowning rates among persons aged ≤ 29 years by sex, age, race/ethnicity, and the U.S. census region from 1999 through 2020. Methods: Data were abstracted from the Centers for Disease Control and Prevention’s WONDER database. International Classification of Diseases Codes, 10th Revision; V90, V92, W65-W74 were used to identify persons aged ≤ 29 years who died of unintentional drowning. Age adjusted mortality rates (AAMR) were extracted by age, sex, race/ethnicity, and U.S. census region. Five-year simple moving averages were used to assess trends overall, and Joinpoint regression models were fitted to estimate average annual percentage changes (AAPC) and annual percentage changes (APC) in AAMR during the study period. 95 % confidence intervals were derived using Monte Carlo Permutation. Results: Between 1999 and 2020, a total of 35,904 persons aged ≤ 29 years died of unintentional drowning in the United States. Mortality rates were highest among males (age adjusted mortality rate (AAMR) = 2.0 per 100,000; 95 % CI: 2.0–2.0), American Indians/Alaska Natives (AAMR = 2.5; 95 % CI: 2.3–2.7), decedents aged 1–4 years (AAMR = 2.8; 95 % CI: 2.7–2.8), and decedents from the Southern U.S. census region (AAMR = 1.7; 95 % CI: 1.6–1.7). Unintentional drowning deaths, overall, have stabilized from 2014 to 2020 (APC = 0.6; 95 % CI: −1.6, 2.8). Recent trends have either declined or stabilized by age, sex, race/ethnicity, and U.S. census region. Conclusions: Unintentional fatal drowning rates have improved in recent years. The results reinforce the need for continued research efforts and improved policies for sustained reduction in trends.