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Temporal trends and demographic risk factors for hospital admissions due to carbon monoxide poisoning in England.

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journal contribution
posted on 14.05.2020, 13:42 by Aina Roca-Barceló, Helen Crabbe, Rebecca Ghosh, Anna Freni-Sterrantino, Tony Fletcher, Giovanni Leonardi, Courtney Hoge, Anna L Hansell, Frédéric B Piel
Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning is a preventable cause of morbidity and mortality. Epidemiological data on UNFR CO poisoning can help monitor changes in the magnitude of this burden, particularly through comparisons of multiple countries, and to identify vulnerable sub-groups of the population which may be more at risk. Here, we collected data on age- and sex- specific number of hospital admissions with a primary diagnosis of UNFR CO poisoning in England (2002-2016), aggregated to small areas, alongside area-level characteristics (i.e. deprivation, rurality and ethnicity). We analysed temporal trends using piecewise log-linear models and compared them to analogous data obtained for Canada, France, Spain and the US. We estimated age-standardized rates per 100,000 inhabitants by area-level characteristics using the WHO standard population (2000-2025). We then fitted the Besag York Mollie (BYM) model, a Bayesian hierarchical spatial model, to assess the independent effect of each area-level characteristic on the standardized risk of hospitalization. Temporal trends showed significant decreases after 2010. Decreasing trends were also observed across all countries studied, yet France had a 5-fold higher risk. Based on 3399 UNFR CO poisoning hospitalizations, we found an increased risk in areas classified as rural (0.69, 95% CrI: 0.67; 0.80), highly deprived (1.77, 95% CrI: 1.66; 2.10) or with the largest proportion of Asian (1.15, 95% CrI: 1.03; 1.49) or Black population (1.35, 95% CrI: 1.20; 1.80). Our multivariate approach provides strong evidence for the identification of vulnerable populations which can inform prevention policies and targeted interventions.


The work of the UK Small Area Health Statistics Unit is funded by Public Health England (PHE) as part of the MRC-PHE Centre for Environment and Health, funded also by the UK Medical Research Council (MRC). The study also received funding from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards at King's College London in partnership with PHE and Imperial College London. The opinions expressed in this article are the authors' own and do not reflect the view of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the United States government, nor do they reflect the views of PHE, the NHS, NIHR, the MRC, the Natural Environment Research Council, or the Department of Health. The population and census data were supplied by the Office for National Statistics (ONS), derived from small area population estimates. Authors would also like to thank the Subdireccion General de Informacion Sanitaria y Evaluacion, Ministerio de Sanidad, Servicios Sociales e Igualdad (Spain); Agnés Verrier and Jessica Gane at the Agence Nationale de Santé Publique (France); Fuyuen Yip and Kanta Sircar at the National Center for Environmental Health, Centers for Disease Control and Prevention (US) for providing data on UNFR CO poisoning hospital data for the respective countries and providing guidance in its interpretation.



Preventive Medicine Volume 136, July 2020, 106104


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