National Surveillance Estimates of Unintentional, Non-fire Related
Carbon Monoxide Poisoning
Jackie Clower, MPHContractor, Air Pollution & Respiratory Health Branch
June 13, 2011
National Center for Environmental HealthDivision of Environmental Hazards and Health Effects
CARBON MONOXIDE (CO)
Colorless, odorless gas
Produced due to incomplete combustion of hydrocarbons
Common routine sources: Home heating & cooking appliances Gas powered equipment Motor vehicles
A leading cause of poisoning in the US
EPIDEMIOLOGY OF UNINTENTIONAL, NON-FIRE-RELATED EXPOSURES
Mortality & Morbidity >20, 000 emergency department visits ~450 deaths
Populations Non-fatal: Children (<5 years), Females Fatal: Elderly (>65 years), Males
Season Winter
Region Midwest Northeast
HEALTH EFFECTS & PREVENTION Non-specific flu-like symptoms:
Fatigue, dizziness, headache, confusion, nausea, vomiting
Collapse, coma, cardio-respiratory failure, & death 15−49% develop neuro-cognitive sequelae
Most cases: Occur in residential settings Preventable with installation of CO alarms
CO SURVEILLANCEFrequency of eventsSeverity of outcomePreventability of exposures
+ Effectiveness of simple preventive measures
= Critical Issue for Public Health Surveillance
CDC developed a national surveillance framework for unintentional, non-fire related CO poisoning from several data sources
CO SURVEILLANCE FRAMEWORK
Mortality
Hospitalization
Hyperbaric oxygen treatment
Emergency department visits
Poison center
National Fire Protection Association
Health Behaviors(e.g., presence of CO alarm at home)
National Vital Statistics System– ~ 450 deaths annually (1999 –2004)
Nationwide Inpatient Sample, 2007– ?
Nationwide Emergency Department Sample, 2007 – ?
Hyperbaric Oxygen , 2009 – ?
American Housing Survey, 2009– 33.4% U.S. households with working CO alarmNational Health Interview Survey, 2009– 40.3% U.S. households with CO alarm
National Poison Data System– ? (2000 – 2009)National Fire Protection Association, 2005 – 61,100 non-fire CO incidents
CO HOSPITALIZATIONSAND ED VISITS: METHODS
Healthcare Cost and Utilization Project (HCUP)
Sponsored by Agency for Healthcare Research and Quality
Largest data repository of hospital discharges Short-term, non-federal, general hospitals Nationally representative samples are drawn
CO HOSPITALIZATION AND ED VISITS: METHODS
Characteristics NEDS 2007
NIS 2007
Participating states 27 40Sample hospitals 966 1,044Sample discharge ~27 mill >8 millTotal weighted sample >122 mill >39 mill
HCUP: Nationwide Emergency Department Sample (NEDS) Nationwide Inpatient Sample (NIS)
CSTE’s case definition used to classify confirmed, probable, & suspected cases
Rates were calculated with Census Bureau population estimates
CO HOSPITALIZATION AND ED VISITS: RESULTS
Highest rate of ED visits among those 18-44 years (87 visits/million)
Highest rate of hospitalization among those ≥85 years (18 stays/million)
Females visited EDs more than males Males more likely to be hospitalized CO-related hospitalization cost was >$26 million
NEDS 2007 NIS 2007
n (%) Rate per million (95% CI)
n (%) Rate per million (95%
CI)Total CO Cases
232,875 772 (764,781) 22, 718 75 (67, 84)
Confirmed CO Cases
21,304 (9.1)
71 (69,72) 2,302 (10.1)
8 (6,9)
CO SURVEILLANCE FRAMEWORK
Mortality
Hospitalization
Hyperbaric oxygen treatment
Emergency department visits
Poison center
National Fire Protection Association
Health Behaviors(e.g., presence of CO alarm at home)
National Vital Statistics System– ~ 450 deaths annually (1999 –2004)
Nationwide Inpatient Sample, 2007– 2,302 confirmed cases
Nationwide Emergency Department Sample, 2007 – 21,304 confirmed cases
Hyperbaric Oxygen , 2009 – ?
American Housing Survey, 2009– 33.4% U.S. households with working CO alarmNational Health Interview Survey, 2009– 40.3% U.S. households with CO alarm
National Poison Data System– ? (2000 – 2009)National Fire Protection Association, 2005 – 61,100 non-fire CO incidents
HYPERBARIC OXYGEN TREATMENT: METHODS
Database of hyperbaric oxygen treatments administered for severe CO poisoning
Undersea and Hyperbaric Medical Society (UHMS) physicians contribute data on patients receiving treatment
August 2008 - January 2010: patient-level data were reported by 87 facilities in 39 states
Case definition: an individual treated with hyperbaric oxygen at a participating facility in the US
HYPERBARIC OXYGEN TREATMENT: METHODS
Panel of 38 questions: Patient demographics Treatment regimens Circumstances surrounding poisonings
Example variables: Number of others treated with hyperbaric oxygen in the same
incident Duration of exposure Symptoms Duration of loss of consciousness % blood carboxyhemoglobin
HYPERBARIC OXYGEN TREATMENT: RESULTS
Among the 864 patients, most were: White (54.3%) Male (57.3%) Aged 18 -44 years (43.5%)
75% exposed along with others 55% of patients were discharged after
treatment 41% were hospitalized
10% of patients reported a CO alarm at their exposure location
CO SURVEILLANCE FRAMEWORK
Mortality
Hospitalization
Hyperbaric oxygen treatment
Emergency department visits
Poison center
National Fire Protection Association
Health Behaviors(e.g., presence of CO alarm at home)
National Vital Statistics System– ~ 450 deaths annually (1999 –2004)
Nationwide Inpatient Sample, 2007– 2,302 confirmed cases
Nationwide Emergency Department Sample, 2007 – 21,304 confirmed cases
Hyperbaric Oxygen , 2009 – 552 cases
American Housing Survey, 2009– 33.4% U.S. households with working CO alarmNational Health Interview Survey, 2009– 40.3% U.S. households with CO alarm
National Poison Data System– ? (2000 – 2009)National Fire Protection Association, 2005 – 61,100 non-fire CO incidents
POISON CENTER CALLS: METHODS Nationally, 61 Poison Centers upload call
data to the National Poison Data System (NPDS)
2.2 million reports annually Includes 36 million reports over last 30
years Case definition:
A call: Regarding a human CO exposure Coded as “unintentional” exposure
Example variables: Demographics Call type: informational vs. exposures Clinical effects: symptoms Exposure site Level of care Outcome
POISON CENTER CALLS: RESULTS 68,316 (23 calls/million/year) CO exposure calls to US poison centers from 2000-2009
28% of calls was regarding persons <18 years (18,896)
50% (34,356) of women & 44% of men (30,257) reported being exposed
235 deaths captured
NPDS provides data regarding CO exposed populations who would not be captured by administrative health records 53.7% (36,691) managed at a healthcare facility 45.1% (30,798) managed onsite & not otherwise
identified
CO SURVEILLANCE FRAMEWORK
Mortality
Hospitalization
Hyperbaric oxygen treatment
Emergency department visits
Poison center
National Fire Protection Association
Health Behaviors(e.g., presence of CO alarm at home)
National Vital Statistics System– ~ 450 deaths annually (1999 –2004)
Nationwide Inpatient Sample, 2007– 2,302 confirmed cases
Nationwide Emergency Department Sample, 2007 – 21,304 confirmed cases
Hyperbaric Oxygen , 2009 – 552 cases
American Housing Survey, 2009– 33.4% U.S. households with working CO alarmNational Health Interview Survey, 2009– 40.3% U.S. households with CO alarm
National Poison Data System– 68,312 exposure calls (2000 – 2009)National Fire Protection Association, 2005 – 61,100 non-fire CO incidents
SUMMARY AND CONCLUSIONS
These analyses expand CO surveillance to include: Most comprehensive, recent national estimates of ED
visits & hospitalizations Most detailed information on patients treated with
hyperbaric oxygen First summary that includes a 10-year period of poison
center calls
Findings from this surveillance framework are critical for prevention efforts as the results contribute to a better understanding of CO poisoning
ACKNOWLEDGEMENTS:Shahed IqbalJeneita BellFuyuen Yip
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: http://www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Environmental HealthDivision of Environmental hazards and Health Effects