Improving coastal safety for international visitors to Australia.

Objectives: International visitors are a high-risk group for drowning and other fatalities at Australian coastal locations due to lower visitation and familiarity than the resident population. This review of pre-COVID-19 (2005-2019) Australian international visitor coastal fatalities aimed to assess changes in mortality rates and evaluate differences between international visitor and resident death profiles to inform safety measures. Study design: Descriptive, retrospective epidemiological analysis. Methods: Analysis of unintentional coastal fatalities among international visitors to Australia from 2005 to 2019 was conducted using coronial data for fatalities and short-term visitor arrival data. Descriptive analysis comprised demographic, and incident-based variables, while cumulative (2005-2019) and annual fatality rates and 95 % confidence intervals per 100,000 short-term arrivals were calculated. Length of stay was incorporated into the risk measurement per 100,000 visitor-years. Joinpoint regression analysed trends in annual visitor coastal fatality rates. Results: Among coastal deaths 62 % were due to drowning; 12.8 % were international visitors; 7.83 residents died for each visitor fatality with an annual average of 22.5 visitor deaths. The cumulative visitor coastal fatality rate was 0.37 deaths per 100,000 international arrivals (95 %CI: 0.33-0.42), which decreased at a statistically significant level by an annual average of 5.8 % (95 %CI: 9.5 % to -1.9 %; p = 0.007) from 2005 to 2019. Visitors record an exposure-adjusted coastal fatality rate of 6.0/100,000 visitor-years. Visitor coastal deaths occurred in higher proportions in Queensland, at offshore locations, in more remote areas, while snorkelling, and during organised activities. Conclusions: Sustained efforts will require focus on high-risk visitor groups by diverse sectors including tourism, government, and water safety practitioners.