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. 2023 Nov;8(11):e839-e849.
doi: 10.1016/S2468-2667(23)00185-8. Epub 2023 Oct 6.

Global, regional, and national mortality due to unintentional carbon monoxide poisoning, 2000-2021: results from the Global Burden of Disease Study 2021

GBD 2021 Carbon Monoxide Poisoning Collaborators
Collaborators

Global, regional, and national mortality due to unintentional carbon monoxide poisoning, 2000-2021: results from the Global Burden of Disease Study 2021

GBD 2021 Carbon Monoxide Poisoning Collaborators. Lancet Public Health. 2023 Nov.

Abstract

Background: Unintentional carbon monoxide poisoning is a largely preventable cause of death that has received insufficient attention. We aimed to conduct a comprehensive global analysis of the demographic, temporal, and geographical patterns of fatal unintentional carbon monoxide poisoning from 2000 to 2021.

Methods: As part of the latest Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), unintentional carbon monoxide poisoning mortality was quantified using the GBD cause of death ensemble modelling strategy. Vital registration data and covariates with an epidemiological link to unintentional carbon monoxide poisoning informed the estimates of death counts and mortality rates for all locations, sexes, ages, and years included in the GBD. Years of life lost (YLLs) were estimated by multiplying deaths by remaining standard life expectancy at age of death. Population attributable fractions (PAFs) for unintentional carbon monoxide poisoning deaths due to occupational injuries and high alcohol use were estimated.

Findings: In 2021, the global mortality rate due to unintentional carbon monoxide poisoning was 0·366 per 100 000 (95% uncertainty interval 0·276-0·415), with 28 900 deaths (21 700-32 800) and 1·18 million YLLs (0·886-1·35) across all ages. Nearly 70% of deaths occurred in males (20 100 [15 800-24 000]), and the 50-54-year age group had the largest number of deaths (2210 [1660-2590]). The highest mortality rate was in those aged 85 years or older with 1·96 deaths (1·38-2·32) per 100 000. Eastern Europe had the highest age-standardised mortality rate at 2·12 deaths (1·98-2·30) per 100 000. Globally, there was a 53·5% (46·2-63·7) decrease in the age-standardised mortality rate from 2000 to 2021, although this decline was not uniform across regions. The overall PAFs for occupational injuries and high alcohol use were 13·6% (11·9-16·0) and 3·5% (1·4-6·2), respectively.

Interpretation: Improvements in unintentional carbon monoxide poisoning mortality rates have been inconsistent across regions and over time since 2000. Given that unintentional carbon monoxide poisoning is almost entirely preventable, policy-level interventions that lower the risk of carbon monoxide poisoning events should be prioritised, such as those that increase access to improved heating and cooking devices, reduce carbon monoxide emissions from generators, and mandate use of carbon monoxide alarms.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests S Afzal reports payment or honoraria from educational events and webinars with King Edward Medical University, Lahore, Pakistan, and collaborative partners including: Johns Hopkins University, Baltimore, MD, USA; University of California, CA, USA; University of Massachusetts, Boston, MA, USA; and University of Lahore, Lahore, Pakistan; participation on a data safety monitoring board or advisory board with the National Bioethics Committee Pakistan, King Edward Medical University Institutional Ethical Review Board, Fatima Jinnah Medical University, Lahore, Pakistan; and Sir Ganga Ram Hospital, Delhi, India; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with the Pakistan Association of Medical Editors, Fellow of Faculty of Public Health Royal Colleges UK, Society of Prevention, Advocacy and Research, King Edward Medical University, and as a member of the Pakistan Society of Infectious Diseases; outside the submitted work. M Carvalho reports grants or contracts from Fundação para a Ciência e a Tecnologia in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences, and project LA/P/0140/2020 of i4HB; outside the submitted work. R C Franklin reports grants or contracts from Heatwaves in Queensland, Queensland Government; Arc Flash, Human Factors, Queensland Government; and Mobile Plant Safety, AgriFutures; honoraria from the World Safety Conference 2022- Conference Convener; support for attending the ACTM Tropical Medicine and Travel Medicine Conference 2022 and ISTM Travel Medicine Conference 2023 in Basel; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with Kidsafe as a Director, Auschem as a Director, ISASH on the Governance Committee, Farmsafe as a Director, and PHAA Injury Prevention SIG as a Convenor; outside the submitted work. K Krishan reports other, non-financial support from the UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India; outside the submitted work. A-F A Mentis reports funding from MilkSafe: a novel pipeline to enrich formula milk using omics technologies, a research co-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call Research–Create–Innovate (project code: T2EDK-02222), and from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); payment or expert testimony as an external peer reviewer for Fondazione Cariplo, Italy; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid, with Systematic Reviews journal as an editorial board member, Annals of Epidemiology and Translational Psychiatry journal as Associate Editor; and other financial or non-financial support as a scientific officer at the BGI Group; outside the submitted work. I Myers reports research grants from CO Research Trust; payment or honoraria from CO Research Trust; support for attending meetings from CO Research Trust; leadership roles in board, society, committee, or advocacy groups, unpaid, with UK All Party Parliamentary CO Group Medical Sub-Group as a Chair, UK Indoor Environments Group as a Committee Member, and OFGEM DRS-GDN as a panel member; outside the submitted work. A E Peden reports support for this paper from The Australian National Health and Medical Research Council Emerging Leadership Fellowship (APPID: APP2009306).

Figures

Figure 1
Figure 1
Global age-standardised mortality rate and number of deaths due to unintentional carbon monoxide poisoning, 2000–21 Shading indicates the upper and lower limits of the 95% uncertainty intervals.
Figure 2
Figure 2
Age-specific deaths (A) and mortality rates (B) due to unintentional carbon monoxide poisoning, by sex and GBD super-region, 2021 GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 3
Figure 3
Global YLLs due to unintentional carbon monoxide poisoning, by age and sex, 2021 Error bars represent the 95% uncertainty interval. YLLs=years of life lost.
Figure 4
Figure 4
Country-specific, age-standardised mortality rate due to unintentional carbon monoxide poisoning in 2021 (A), and percentage change from 2000 to 2021 (B)
See this image and copyright information in PMC

Comment in

  • Carbon monoxide poisoning: largely preventable.
    The Lancet Public Health. The Lancet Public Health. Lancet Public Health. 2023 Nov;8(11):e827. doi: 10.1016/S2468-2667(23)00249-9. Lancet Public Health. 2023. PMID: 37898510 No abstract available.

References

    1. Graber JM, Macdonald SC, Kass DE, Smith AE, Anderson HA. Carbon monoxide: the case for environmental public health surveillance. Public Health Rep. 2007;122:138–144. - PMC - PubMed
    1. Rupert DJ, Poehlman JA, Damon SA, Williams PN. Risk and protective behaviours for residential carbon monoxide poisoning. Inj Prev. 2013;19:119–123. - PMC - PubMed
    1. Ball LB, Macdonald SC, Mott JA, Etzel RA. Carbon monoxide-related injury estimation using ICD-coded data: methodologic implications for public health surveillance. Arch Environ Occup Health. 2005;60:119–127. - PubMed
    1. Liu F, Jiang X, Zhang M. Global burden analysis and AutoGluon prediction of accidental carbon monoxide poisoning by Global Burden of Disease Study 2019. Environ Sci Pollut Res Int. 2022;29:6911–6928. - PubMed
    1. Braubach M, Algoet A, Beaton M, Lauriou S, Héroux M-E, Krzyzanowski M. Mortality associated with exposure to carbon monoxide in WHO European Member States. Indoor Air. 2013;23:115–125. - PubMed

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