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. 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.

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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

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