November 27, 2019
2 min read

Object-related choking deaths down significantly in US children since 1968

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John D. Cramer, MD
John D. Cramer

Object-related aspiration deaths in U.S. children declined 75% over 50 years, aided in part by policy changes to address choking hazards, according to a study published in JAMA Pediatrics.

“Over 20,000 children died preventable deaths in our study period from choking on objects,” John D. Cramer, MD, assistant professor in the department of otolaryngology-head and neck surgery at Wayne State University School of Medicine, told Infectious Diseases in Children. “We believe that several policy changes over the last 50 years have helped to decrease these preventable deaths to one-quarter of previous rates.”

Cramer and colleagues examined 20,629 cases of object-related aspiration deaths in children and adolescents aged 17 years or younger that occurred from 1969 to 2017 and were recorded in the National Vital Statistics System. Food-related aspiration deaths were excluded, and deaths were identified using codes from the eighth, ninth and 10th revisions of the International Classification of Diseases.

Total object-related aspiration deaths among children declined from 1.02 per 100,000 (719 deaths) in 1968 to 0.25 per 100,000 (184 deaths) in 2017, with an annual percentage decrease of 2% (95% CI, –1.6% to –2.3%) from 1968 to 1990, 6.1% (95% CI, –4.9% to –7.2%) from 1990 to 2003 and 2.5% (95% CI, –1.3% to –3.7%) from 2003 to 2017.


They also observed a decline among children aged younger than 3 years, with annual percentage decreases of 2.8% (95% CI, –2.4% to –3.3%) from 1968 to 1991, 8.4% (95% CI, –4.8% to –11.8%) from 1991 to 1999 and 2.4% (95% CI, –1.3% to –3.5%) from 1999 to 2017. Mortality was stable in children aged 3 years or older from 1968 to 1976, with annual percentage decreases of 2.1% (95% CI, –1.2% to –3.1%) from 1976 to 1992 and 4.5% (95% CI, –3.9% to –5.1%) from 1992 to 2017.

“The most surprising data to me was the decline in mortality in children under age 3,” Cramer said. “This is a developmental stage where kids are oral and exploratory, and often put things in their mouths and has been the focus of many of the regulatory changes and warning labels.”

Although Cramer and colleagues believe policy changes have aided in the decline of choking mortality, no specific policies can be pinpointed as the root cause, according to Cramer.

“We do not know the specific object that was aspirated,” Cramer said. “As there were multiple policy changes over the 50-year period we cannot determine which changes specifically contributed to the decrease in mortality.” – by Eamon Dreisbach

Disclosure: Cramer reports no relevant financial disclosures.