In the Croatian sample, the majority of victims were foreign citizens (59.6%), most of whom fell victim to scuba diving (70.4%); this is in contrast to resident divers who succumbed during free-diving

(79%). The greatest number of scuba diving fatalities among locals was related to professional and technical diving. Similar data were also recorded in the southern part of Croatia, Split-Dalmatian County.[24] The higher ratio of foreign citizens in the overall number of deaths, and their significant rise after 1996, can be explained by the substantial ratio of foreign divers in the country, especially in the post-war period when diving tourism in Croatia GSK-3 cancer took off[25] (unofficial data report that the number of foreign divers is rising at an annual rate of 15%–20% and that they make up almost 80% of the reported divers[12, 26]). The striking difference in diving styles among locals and tourists can be explained by

economic and cultural factors which induce a greater number of Croatian divers to practice free-diving for leisure while participating INK 128 mw in scuba diving for professional reasons. In addition, fatally injured foreign divers are often people who start to participate in the sport later in life when they have achieved financial autonomy and mobility (as scuba diving is a financially demanding sport). Being significantly older than local divers, they have a greater number of preexisting pathologies that could easily trigger ADAMTS5 a fatal outcome. The main limitation of the study was the inability to clearly establish the population at risk (the exact number of divers in the county) due to the lack of a continuous systematic monitoring system of scuba divers during the 30-year period. The number of free-divers is unknown and impossible to estimate as their activity is not controlled by law or regulations. However, the existing data document a continuous

increase in the number of divers in Croatia, the number rising from 42,000 in 2001[27] to more than 60,000 by the end of the decade[11] (with approximately 14,000 divers and 25,000 dives reported in Primorje-Gorski Kotar County in 2009[26]). Despite this limitation, the systematic collection and analysis of data regarding diving accidents in the Primorje-Gorski Kotar region has shown that there is a need for stricter monitoring of diving tourism, regular health check-ups for senior divers and, most importantly, a legally regulated monitoring and education system for free-divers. Today, modern diving can be, in every sense, equated with diving tourism.