Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 22;20(8):e0330778.
doi: 10.1371/journal.pone.0330778. eCollection 2025.

Global patterns and trends of carbon monoxide poisoning: A comprehensive spatiotemporal analysis using joinpoint regression and ARIMA modeling, 1990-2021

Weiguang Wang  1 , Yongai Ling  1 , Xianwei Xiong  1 , Jiajie Zhou  2
Affiliations

Global patterns and trends of carbon monoxide poisoning: A comprehensive spatiotemporal analysis using joinpoint regression and ARIMA modeling, 1990-2021

Weiguang Wang et al. PLoS One. .

Abstract

Background: Carbon monoxide (CO) poisoning causes approximately 41,000 deaths annually worldwide despite being preventable. Previous studies focused primarily on mortality alone, lacked systematic socio-demographic analysis, and provided no predictive models. This study comprehensively analyzes global CO poisoning patterns using spatiotemporal methods to inform evidence-based prevention strategies.

Methods: We analyzed Global Burden of Disease Study 2021 data from 204 countries (1990-2021) for age-standardized incidence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression identified temporal trends with statistical precision, spatial statistics quantified geographic clustering, and ARIMA modeling projected trends through 2050. We examined associations with socio-demographic index (SDI) across regions and countries.

Results: Global age-standardized incidence rates decreased significantly by 35.1% from 12.13 (95% UI: 8.30-17.00) to 7.87 (95% UI: 5.54-10.81) per 100,000 population (annual percentage change: -1.16%, 95% UI: -1.35% to -0.96%, p < 0.001). Mortality rates declined more dramatically by 53.9% from 0.76 (95% UI: 0.66-0.91) to 0.35 (95% UI: 0.24-0.40) per 100,000 (annual change: -2.79%, 95% UI: -3.14% to -2.44%, p < 0.001). DALY rates showed the steepest reduction of 59.5% from 37.59 (95% UI: 31.75-44.76) to 15.22 (95% UI: 10.67-17.57) per 100,000 (annual change: -3.18%, 95% UI: -3.51% to -2.84%, p < 0.001). Eastern Europe demonstrated the highest burden (37.98 per 100,000 in 2021). Males experienced significantly higher mortality than females (0.50 vs 0.20 per 100,000, p < 0.001). SDI analysis revealed an inverted U-shaped relationship (Spearman's r = 0.76, p < 0.001), with peak burden at moderate development levels (SDI: 0.6-0.7).

Conclusions: These findings directly address previous research gaps by demonstrating: (1) faster mortality decline than incidence decline indicates improved global treatment capabilities; (2) the SDI-burden relationship identifies moderate-development countries as priority intervention targets; (3) significant male predominance (2.5-fold higher mortality) supports gender-specific prevention programs; and (4) persistent Eastern European hotspots require targeted infrastructure improvements. Predictive models forecast continued decline through 2050 and enable evidence-based healthcare planning. This comprehensive analysis provides the first multi-dimensional global assessment, offering crucial evidence for differentiated prevention strategies worldwide.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Geographic distribution of age-standardized incidence rates of acute carbon monoxide poisoning (per 100,000 population) in 2021.
Disease burden data from Global Burden of Disease Study 2021; Map data from Natural Earth (https://www.naturalearthdata.com/), public domain.
Fig 2
Fig 2. Geographic distribution of age-standardized mortality rates of acute carbon monoxide poisoning (per 100,000 population) in 2021.
Disease burden data from Global Burden of Disease Study 2021; Map data from Natural Earth (https://www.naturalearthdata.com/), public domain.
Fig 3
Fig 3. Geographic distribution of age-standardized DALY rates of acute carbon monoxide poisoning (per 100,000 population) in 2021.
Disease burden data from Global Burden of Disease Study 2021; Map data from Natural Earth (https://www.naturalearthdata.com/), public domain.
Fig 4
Fig 4. Association between socio-demographic index and age-standardized incidence rates across 21 global regions.
Fig 5
Fig 5. Association between socio-demographic index and age-standardized mortality rates across 21 global regions.
Fig 6
Fig 6. Association between socio-demographic index and age-standardized DALY rates across 21 global regions.
Fig 7
Fig 7. Association between socio-demographic index and age-standardized incidence rates across 204 countries.
Fig 8
Fig 8. Association between socio-demographic index and age-standardized mortality rates across 204 countries.
Fig 9
Fig 9. Association between socio-demographic index and age-standardized DALY rates across 204 countries.
Fig 10
Fig 10. Projected trends in age-standardized incidence rates of acute carbon monoxide poisoning through 2050.
Fig 11
Fig 11. Projected trends in age-standardized mortality rates of acute carbon monoxide poisoning through 2050.
Fig 12
Fig 12. Projected trends in age-standardized DALY rates of acute carbon monoxide poisoning through 2050.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Dent MR. Carbon monoxide poisoning: from microbes to therapeutics. Annual Rev Med. 2024;75:337–51. - PMC - PubMed
    1. Rose JJ. Carbon monoxide poisoning: pathogenesis, management, and future directions of therapy. Am J Resp Crit Care Med. 2017;195(5):596–606. - PMC - PubMed
    1. Hampson NB, Piantadosi CA, Thom SR, Weaver LK. Practice recommendations in the diagnosis, management, and prevention of carbon monoxide poisoning. Am J Respir Crit Care Med. 2012;186(11):1095–101. doi: 10.1164/rccm.201207-1284CI - DOI - PubMed
    1. Iqbal S, Clower JH, King M, Bell J, Yip FY. National carbon monoxide poisoning surveillance framework and recent estimates. Public Health Rep. 2012;127(5):486–96. doi: 10.1177/003335491212700504 - DOI - PMC - PubMed
    1. Cobb N, Etzel RA. Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988. JAMA. 1991;266(5):659–63. doi: 10.1001/jama.1991.03470050059023 - DOI - PubMed