Racial and ethnic trends in unintentional carbon monoxide poisoning deaths.

OBJECTIVE: Government programs have attempted to impact a recognized elevated risk for carbon monoxide (CO) poisoning among minority racial and ethnic groups. This study sought to describe U.S. mortality due to unintentional, non-fire-related CO poisoning, examining the distribution and trends by race and ethnicity. METHODS: CDC Wonder was used to extract and analyze data on all U.S. resident deaths from unintentional CO poisoning from 2000-2017, categorizing them by year, race, ethnic origin and gender. RESULTS: The absolute number of unintentional CO deaths decreased from about 450 to 380 per year during the period studied, a number near totally accounted for by the decrease in deaths occurring among non-Hispanic/Latino whites. The number of deaths among the remainder of the population did not significantly change. However, greater growth in minority populations resulted in a similar decline in the mortality rate between non-Hispanic/Latino whites and the combined minority population. The decline in combined minority death rate resulted from a decrease in the Hispanic/Latino white rate. Death rate did not decline in the black or African American population. CONCLUSIONS: All minority groups continue to display a disproportionate number of unintentional non-fire-related CO poisoning deaths compared to non-Hispanic/Latino whites. The decrease in U.S. deaths from unintentional non-fire-related carbon monoxide poisoning from 2000-2017 is accounted for by a decrease in non-Hispanic/Latino white deaths. While numbers of such deaths among minority groups have not changed since 2000, increases in the size of minority populations have resulted in a declining crude death rate for Hispanic/Latino whites.

Two Storm-Related Carbon Monoxide Poisoning Outbreaks­Connecticut, October 2011 and October 2012.

Storm-related carbon monoxide (CO) poisoning outbreaks occurred in Connecticut in 2011 and 2012, despite efforts to improve public messaging. We describe the cases and incidents and identify possible preventive interventions. We defined cases as blood carboxyhemoglobin ≥9.0% among persons exposed to alternative power or heat sources because of storm-related losses. We identified 133 cases, including 3 deaths, in 2011 and 30 in 2012, associated with 72 and 11 incidents, respectively. Racial/ethnic minorities were overrepresented (60% of 2011 patients; 48% in 2012), compared with Connecticut's minority population (29%). Generator or charcoal misuse (83% in 2011; 100% in 2012) caused the majority of incidents. Few CO-source operators recalled media or product CO warnings. Incorrect generator and charcoal use, racial/ethnic disparities, and incomplete penetration of warning messages characterized both outbreaks. A multifaceted approach is needed to decrease postdisaster CO poisonings.

Occupational carbon monoxide fatalities in the US from unintentional non-fire related exposures, 1992-2008.

OBJECTIVE: To analyze characteristics of, and trends in, work-related carbon monoxide (CO) fatalities in the US. METHODS: Records of unintentional, non-fire related fatalities from CO exposure were extracted from the Bureau of Labor Statistics' Census of Fatal Occupational Injuries and the Occupational Safety and Health Administration's Integrated Management Information System for years 1992-2008 and analyzed separately. RESULTS: The average number of annual CO fatalities was 22 (standard deviation=8). Fatality rates were highest among workers aged≥65, males, Hispanics, winter months, the Midwest, and the Fishing, Hunting, and Trapping industry subsector. Self-employed workers accounted for 28% of all fatalities. Motor vehicles were the most frequent source of fatal CO exposure, followed by heating systems and generators. CONCLUSIONS: CO has been the most frequent cause of occupational fatality due to acute inhalation, and has shown no significant decreasing trend since 1992. The high number of fatalities from motor vehicles warrants further investigation.

Review of unintentional non-fire-related carbon monoxide poisoning morbidity and mortality in Florida, 1999-2007.

OBJECTIVE: Previous Florida evaluations of carbon monoxide (CO) poisoning have been disaster focused. The majority of prevention messages and risk-factor identification efforts have revolved around hurricane season (June-November). We evaluated the prevalence, risk factors, and causes of CO poisoning within Florida throughout the year to produce a more complete presentation of the burden of CO poisoning. METHODS: We obtained data from death certificates, hospital discharge records, and emergency department records. We limited our analysis to unintentional poisonings, calculating rates for age, gender, race, and ethnicity, and reviewing poisoning chronology, location, and exposure situation. RESULTS: From 1999 to 2007, 493 people were hospitalized, and 230 individuals died as a result of non-fire-related CO poisoning. From 2005 to 2007, 781 people visited emergency departments for non-fire-related CO poisoning. Rates of severe poisoning resulting in hospitalization or death were highest among the elderly (0.56 visits and 0.63 deaths per 100,000 Floridians). Acute poisoning rates were highest among people 25-34 years of age (2.48 visits per 100,000 Floridians). Poisonings were primarily due to motor vehicle exhaust (21%-69%) and generator exposure (12%-33%), and the majority (50%-70%) occurred within the home. A large number of poisonings (25%-29%) occurred during the winter months, outside of hurricane season. CONCLUSION: The findings of this study indicate a need for additional prevention strategies in conjunction with current activities to more effectively reduce the number of CO poisonings in Florida. Prevention activities should be conducted year-round, and additional strategies should include public awareness of the hazards of motor vehicle exhaust.

Monthly variations in the diagnosis of carbon monoxide exposures in the emergency department.

INTRODUCTION: Carbon monoxide (CO) poisoning is the leading cause of toxicological deaths worldwide. Symptoms may be subtle, contributing to its frequent delay in diagnosis. If a seasonal variation occurs, a heightened awareness during peak time may lead to improved recognition and diagnosis. STUDY OBJECTIVES: To determine whether monthly variations in CO poisoning occur in emergency departments. DESIGN: A multicenter retrospective emergency department (ED) cohort. STUDY SETTING: 23 New Jersey and New York emergency departments. SUBJECTS: Consecutive patients with the ICD-9 primary diagnosis of"toxic effects CO" from January 1, 2000 to October 31, 2006. STATISTICS: We tested for significant differences using chi-square and Student's t-test with alpha set at 0.5. RESULTS: There were 1,006 patients who were diagnosed in the ED with CO toxicity (0.024% of all ED patients). Mean age was 30 years (SD +/- 20), 54% were female, and Caucasians compromised 54% of participants. Thirty-nine percent of documented patients arrived via ambulance and 90% were subsequently discharged. Incidence of CO visits peaked in December (0.036%) and were least likely in May (0.011%). Mean monthly CO visits were statistically increased during October (p = < 0.0001), November (p = 0.008), December (< 0.0001), January (p = 0.01), and March (p = 0.04). Statistically fewer case of CO exposure were diagnosed in May (p = 0.0003), June (p = 0.005), August (p = < 0.0001), and September (p = 0.002).

Carbon monoxide epidemic among immigrant populations: King County, Washington, 2006.

OBJECTIVES: We investigated an outbreak of carbon monoxide (CO) poisoning after a power outage to determine its extent, identify risk factors, and develop prevention measures. METHODS: We reviewed medical records and medical examiner reports of patients with CO poisoning or related symptoms during December 15 to 24, 2006. We grouped patients into households exposed concurrently to a single source of CO. RESULTS: Among 259 patients with CO poisoning, 204 cases were laboratory confirmed, 37 were probable, 10 were suspected, and 8 were fatal. Of 86 households studied, 58% (n = 50) were immigrant households from Africa (n = 21), Asia (n = 15), Latin America (n = 10), and the Middle East (n = 4); 34% (n = 29) were US-born households. One percent of households was European (n = 1), and the origin for 7% (n = 6) was unknown. Charcoal was the most common fuel source used among immigrant households (82%), whereas liquid fuel was predominant among US-born households (34%). CONCLUSIONS: Educational campaigns to prevent CO poisoning should consider immigrants' cultural practices and languages and specifically warn against burning charcoal indoors and incorrect ventilation of gasoline- or propane-powered electric generators.

Epidemiology of severe carbon monoxide poisoning in children.

OBJECTIVE: To describe the characteristics of severe pediatric CO poisoning cases treated with hyperbaric oxygen (HBO2) to determine key features that might aid prevention efforts. DESIGN: Using data on 250 consecutive children treated with HBO2 for CO poisoning at Virginia Mason Medical Center in Seattle, we calculated descriptive statistics and used Fisher's Exact test to determine differences in case frequency of CO sources with respect to race/ethnicity. RESULTS: There were 236 (94%) unintentional and 14 (6%) intentional poisonings. Loss of consciousness occurred in 50%. The average initial carboxyhemoglobin level was 19.0 +/- 10.3% (mean +/- SD; range 0.3% to 57.6%). Months with the highest proportion of incidents were November (15%), December (12%) and January (14%). Children 0-2 years old were most often poisoned by charcoal briquettes (40%), in contrast to older children who were most often poisoned by motor vehicle. Females were most often poisoned by charcoal briquettes (28%), in contrast to males in which motor vehicle exhaust predominated (41%). Minorities were disproportionately affected by CO poisoning compared with non-Latino whites (P < 0.001). Overall, motor vehicle exhaust predominated for Non-Latino whites (33%), while Non-Latino blacks (55%) and Latinos (71%) had significantly higher proportions of poisonings by charcoal briquettes (P < 0.001). All intentional cases occurred in adolescents aged 15 to 17 years, 71% of these in males, mostly by motor vehicle exhaust (79%). CONCLUSIONS: Severe pediatric CO poisoning demonstrates a seasonal pattern with key sources of exposure varying by gender, age, and race/ethnicity. Minorities are at increased risk for severe CO poisoning. Intentional CO poisoning occurs primarily among adolescent males and by motor vehicle exhaust. Prevention efforts should take these factors into consideration.

Does public education reduce ice storm-related carbon monoxide exposure?

Public education to prevent carbon monoxide exposure during ice storms has been recommended; its effects remain unexamined. We compared patients seen for carbon monoxide inhalation at the area's only academic Emergency Department during 1991 and 2003 ice storms; educational efforts were more intense in 2003. There were fewer patients during the second storm (45 vs. 55); all recovered fully. The percentage of Caucasian patients rose (from 57% to 89%) whereas that of African-American patients fell (from 39% to 7%). Indoor grill use, associated with 11% of 1991 cases, was eliminated in 2003. Indoor gas generators remain the most common source. Carboxyhemoglobin levels correlate poorly with ambient carbon monoxide levels. Enhanced public education had a modest effect, especially in reducing the proportion of African-American patients and those from indoor grill use. Research on more effective public health education targeted at gas generator users and combined with physical interventions should be considered.

Charcoal-burning suicide in post-transition Hong Kong.

BACKGROUND: Charcoal-burning, a new suicide method, emerged in Hong Kong during the latest economic recession. Within 2 months charcoal-burning had become the third most common suicide method. AIMS: To examine the characteristics of suicides by charcoal-burning, and to delineate the pathways linking macro-level economic and social changes with the subjective experiences of those surviving a charcoal-burning suicide attempt. METHOD: Both quantitative and qualitative methods were used. In the coroner's records study, the first 160 cases of suicide by charcoal-burning were compared with a control group. In the ethnographic enquiry, we interviewed 25 consecutive informants who had survived serious suicide attempt using charcoal-burning. RESULTS: People who completed suicide by the charcoal-burning method were more likely to have been economically active and physically healthy, and were less likely to have had pre-existing mental illness. Charcoal-burning suicide was associated with overindebtedness. Media reports were pivotal in linking overindebtedness and financial troubles with charcoal-burning. CONCLUSIONS: The political economy of suicide by charcoal-burning illustrated how historical, socio-economic and cultural forces shaped the lived experience that preceded suicide.

Carbon monoxide poisoning as a new method of suicide in Hong Kong.

The incidence in Hong Kong of intentional carbon monoxide poisonings by burning charcoal in a confined space was investigated. In the two-year study period, 22 (39 percent) of the 56 reported cases occurred in the three months following a highly publicized case in which this method was used to commit suicide; no cases were reported before the publicized incident. Individuals who used this method were younger on average (mean, 39 years) than those who used the more common methods of jumping (mean, 47 years) and hanging (mean, 55 years). The authors speculate that this form of suicide is becoming more prevalent because it has been highly publicized, it is easily carried out, and it is culturally acceptable.