Epidemiology
Worldwide, the incidence of CO poisoning has not changed significantly since the 1990s, but mortality has declined markedly during this period.[8] Incidence of poisoning is higher in middle and middle-to-high than in low-to-middle socio-demographic index (SDI) countries.[8] However, primary data about CO poisoning in many countries is unreliable, particularly in areas where the infrastructure for accurate diagnosis may not be available (e.g., remote or resource-poor regions).[8] In the US, the best available estimates of the yearly incidence of carbon monoxide poisoning are 50,000 (intentional and accidental), based on emergency department visits.[4] There are two main peaks of incidence of CO poisoning; one in people ages 0 to 14 years and another in those ages 20 to 39 years.[8] The highest rate of mortality following poisoning is in those ages over 80 years.[8] The incidence of poisoning is reported to be the same in men and women worldwide, but men have a higher mortality compared with women.[8][9]
Approximately half of cases are accidental and nonfire-related.[10] Of the estimated 250 unintentional nonfire deaths attributed to CO poisoning reported in 2019 in the US, over half were associated with engine-driven tools (e.g., generators, lawn mowers, tillers). Heating appliances were associated with the second largest percentage of deaths.[11]
There is a seasonal predominance with higher rates of death reported in winter, and a regional predominance with higher rates of death in the northern states.[12] A reduction in unintentional deaths from approximately 20 to 9 per million person-years between 1968 and 1998 was attributed to the Clean Air Act 1970 and use of catalytic converters in automobiles since 1975.[6]
Risk factors
A variety of sources generate CO, including internal combustion engines, water heaters, and home heating units. Kerosene space heaters were responsible for CO poisoning in the 1970s. Other sources of CO exposure are the paper mill industry, steel mills, explosives used in construction, petroleum refineries, and gasoline-or propane-powered machinery.[12][22][23]
CO is formed during metabolism of methylene dichloride (dichloromethane). Exposure to CO during paint or furniture stripping and degreasing may result in poisoning.[25]
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