Fatal unintentional non-fire-related carbon monoxide poisoning: England and Wales, 1979-2012

Clinical Toxicology (Impact Factor: 3.67). 02/2014; 52(3). DOI: 10.3109/15563650.2014.887092
Source: PubMed


Unintentional carbon monoxide poisoning remains a significant cause of morbidity and mortality in England and Wales. METHODS.

Study design:
observational case series. Data on fatal carbon monoxide poisoning in England and Wales from 1979 to 2012 were obtained from coroner reports. Data on unintentional non-fire-related carbon monoxide poisoning were extracted and were analysed by year of registration of death, sex, age group, and whether death occurred at a private house, flat, associated garage, or residential caravan ('home'), or elsewhere.

Results and discussion:
There were 28,944 carbon monoxide-related deaths, of which 82% were male. Deaths increased from 965 (1979) to 1700 (1987), and then fell to 182 (2012). Of these 2208 (64% male) were recorded as unintentional non-fire-related deaths. Annual numbers of these latter deaths fell from 166 in 1979 to 25 in 2012 (i.e. from 3.37 to 0.44 per million population). Some 81 and 92% of such deaths in males and in females, respectively, occurred at 'home'. A clear preponderance of male versus female deaths was seen in the 10-19, 20-39 and 40-64 years age groups, with similar numbers of deaths in males and in females in the younger (< 1 and 1-9 year) and higher (65-79 and 80 + years) age groups. A higher proportion of these excess deaths in males occurred outside the deceased's 'home' in those aged 10-19, 20-39 and 40-64 years.

Deaths from unintentional non-fire-related carbon monoxide poisoning are now much less common in England and Wales than in earlier years, but remain a cause for concern. Installation and proper maintenance of carbon monoxide alarms in dwellings and outhouses, for example, and education not only of the public, but also of health and other professionals as to the danger posed by carbon monoxide could help prevent such deaths.

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    ABSTRACT: Accidental non-fire-related (ANFR) carbon monoxide (CO) poisoning is a cause of fatalities and hospital admissions. This is the first study that describes the characteristics of ANFR CO hospital admissions in England. Hospital Episode Statistics (HES) inpatient data for England between 2001 and 2010 were used. ANFR CO poisoning admissions were defined as any mention of ICD-10 code T58: toxic effect of CO and X47: accidental poisoning by gases or vapours, excluding ICD-10 codes potentially related to fires (X00-X09, T20-T32 and Y26). There were 2463 ANFR CO admissions over the 10-year period (annual rate: 0.49/100 000); these comprised just under half (48.7%) of all non-fire-related (accidental and non-accidental) CO admissions. There was seasonal variability, with more admissions in colder winter months. Higher admission rates were observed in the north of England. Just over half (53%) of ANFR admissions were male, and the highest rates of ANFR admissions were in those aged >80 years. The burden of ANFR CO poisoning is preventable. The results of this study suggest an appreciable burden of CO and highlight differences that may aid targeting of public health interventions. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health.
    Journal of Public Health 03/2015; DOI:10.1093/pubmed/fdv026 · 2.04 Impact Factor
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    ABSTRACT: Background: The epidemiology of mortality and morbidity from carbon monoxide poisoning in Canada has received little attention. Our objective was to evaluate trends in mortality and hospital admission rates for unintentional nonfire-related carbon monoxide poisoning across Canada. Methods: Age- and sex-standardized mortality (1981-2009) and hospital admission (1995-2010) rates by age group, sex and site of carbon monoxide exposure were calculated for each province and for all of Canada. We quantified the long-term trends by calculating the average annual percent change. Multivariable Poisson regression was used to estimate incidence rate ratios (IRRs) of carbon monoxide poisoning across age groups, sex and month of occurrence. Results: In Canada, there were 1808 unintentional nonfire-related carbon monoxide poisoning deaths between 1981 and 2009 and 1984 admissions to hospital between 1995 and 2010. Average annual decreases of 3.46% (95% confidence interval [CI] -4.59% to -2.31%) and 5.83% (95% CI -7.79% to -3.83%) were observed for mortality and hospital admission rates, respectively. Mortality (IRR 5.31, 95% CI 4.57 to 6.17) and hospital admission (IRR 2.77, 95% CI 2.51 to 3.03) rates were elevated in males compared with females. Decreased trends in the rates were observed for all sites of carbon monoxide exposure, but the magnitude of this decrease was lowest in residential environments. Deaths and admissions to hospital were most frequent from September to April, with peaks in December and January. Interpretation: Mortality and hospital admission rates for unintentional nonfire-related carbon monoxide poisoning in Canada have declined steadily. Continued efforts should focus on reducing carbon monoxide poisoning during the cooler months and in residential environments.
    04/2015; 3(2):E223-E230. DOI:10.9778/cmajo.20140122