U.S. Mortality Due to Carbon Monoxide Poisoning, 1999–2014. Accidental and Intentional Deaths

RATIONALE: Carbon monoxide (CO) poisoning accounts for hundreds of deaths and thousands of emergency department visits in the United States annually. Development of initiatives to reduce CO mortality through poisoning prevention requires a comprehensive understanding of the condition. OBJECTIVES: To describe U.S. mortality from 1999 to 2014 due to CO poisoning from all sources except fires, to examine the epidemiology of accidental and intentional exposures, and to identify trends. METHODS: The CDC WONDER database was used to extract and analyze data from the CDC's Multiple Cause of Death 1999-2014 file. The file contains mortality data derived from all death certificates filed in the United States. MEASUREMENTS AND MAIN RESULTS: Information on deaths, crude death rate, age-adjusted death rate, intent of exposure, and characteristics of exposures from CO poisoning was extracted. Total deaths by CO poisoning decreased from 1,967 in 1999 to 1,319 in 2014 (P < 0.001). Crude and adjusted death rates fell accordingly. Accidental poisoning accounted for 13% fewer deaths per year in 2014 than in 1999 (P < 0.001). The number of intentional deaths by CO poisoning decreased by 47% over the same period (P < 0.001). The rate of decline in combined adjusted death rates from 1999 to 2014 in the 19 states that required residential CO alarms by 2010 was not different from that for the 31 states that did not require residential alarms (P = 0.982). CONCLUSIONS: Numbers of deaths and death rates, both accidental and intentional, due to CO poisoning significantly declined in the United States from 1999 to 2014. Continued public education about CO toxicity should be emphasized. Additional study is needed to demonstrate the efficacy of residential CO alarms.