Carbon Monoxide Poisoning Skewed Toward Minority Groups

Emma Hitt, PhD

August 16, 2012

August 16, 2012 — Racial/ethnic minorities represent a disproportionate fraction of both fatal and nonfatal disaster-related carbon monoxide (CO) exposures, according to a new Centers for Disease Control and Prevention (CDC) report — the first comprehensive assessment of the issue.

Shahed Iqbal, PhD, MBBS, from the Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, at the CDC's National Center for Environmental Health, and colleagues published their findings online August 16 in the American Journal of Public Health.

According to the researchers, unintentional, non-fire-related CO poisoning result in more than 20,000 emergency department visits, more than 2000 hospitalizations, and nearly 450 deaths per year. Furthermore, CO is a tasteless, odorless gas with nonspecific symptoms of toxicity, and exposure may be underdiagnosed or misdiagnosed.

In addition, CO poison has been "reported to be a leading cause of mortality and morbidity in postdisaster situations when engagement in high-risk behaviors is more common (e.g., improper placement of generators, use of charcoal grills indoors)," Dr. Iqbal and colleagues note.

"Power outages during disasters or postdisaster cleanup and recovery have been found to be primarily responsible for a large number of fatal and nonfatal disaster-related CO exposures," the authors add. "It is important to identify and characterize high-risk populations and circumstances leading to disaster-related CO exposures to better target public health interventions and health messaging."

The researchers sought to better understand the aspects of disaster-related CO poisoning surveillance, characterize the populations at risk, and determine potentially effective prevention.

The CDC evaluated data from 28 journal articles on disaster-related CO poisoning cases that occurred between 1991 and 2009 in the United States. Among the cases, there were 362 incidents that were considered "disasters" and 1888 disaster-related CO poisoning cases reported, with 75 fatalities.

Among the 75 fatalities, 88% were in people older than 18 years, and 79% were male. In addition, racial/ethnic groups were disproportionally affected: Although making up just 3.5% and 4.2% of the US population, respectively, Hispanics and Asians accounted for 20% and 14% of fatal cases and 21% and 7% of nonfatal cases, respectively.

Generators were implicated as the primary source of exposure in 83% of fatal and 54% of nonfatal cases, and about two thirds of fatal cases were caused by indoor generator placement. In addition, charcoal grills were a major source of exposure during winter storms.

Nearly all fatalities occurred at home, and about 89% of fatal and 53% of nonfatal cases occurred within 3 days of disaster onset.

According to the researchers, the "public does not always perceive CO poisoning as a major health concern or is not aware of safe health practices," and they add that "information is sometimes not widely received by affected populations.... These findings emphasize the continued need for communicating CO-related health information and surveillance of CO poisoning cases as a central component of public health emergency preparedness, response, and prevention efforts during natural disasters," they suggest.

The authors have disclosed no relevant financial relationships.

Am J Public Health. Published online August 16, 2012.


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