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Carbon monoxide poisoning in private dwellings

Carbon monoxide (CO) is a very common environmental hazard in the UK and is a known cause of a significant number of fatalities and hospital admissions from accidental poisoning. Some of the associated morbidity is not well characterized as poisoning and is often undiagnosed.

Environmental public health tracking will facilitate surveillance of health events coded as having been caused by carbon monoxide and will relate these events to known carbon monoxide hazards at population level such as building related factors (gas appliance failures and ventilation defects) and the interventions available to address these problems. This is an example of 'outcome tracking'.

Public Health England aim to facilitate the understanding of interventions that could be designed to reduce the impact of a series of related hazards. To achieve this, the following 10 steps have been identified:

  1. design of CO-related tracking programme
  2. surveillance of routine health data
  3. surveillance of actively collected CO-incident data
  4. other CO-related hazard tracking, from the health point of view
  5. CO-related hazard tracking, from housing point of view – gas appliances
  6. CO-related hazard tracking, from housing point of view – accidental house fires
  7. environmental evaluation
  8. public health evaluation
  9. risk communication
  10. risk management

Hazard tracking flow diagram

Hazard tracking flow diagram for carbon monoxide 

Progress on PHE carbon monoxide tracking projects

Better understanding of carbon monoxide (CO) related mortality

We are working with the Office for National Statistics (ONS) in Newport to conduct a review of Coroners Narratives data, to gain intelligence about the causes and situations of deaths, to inform interventions and advice.

Hospital episode statistics (HES) – inpatient episodes on acute CO poisonings

Analysis of HES inpatient data for carbon monoxide hospital admissions in England. We are working with Imperial College’s Small Area Health Statistics Unit (SAHSU) [external link] to provide an update of the HES analysis to examine trends over time, seasonal trends and rates by ethnicity and deprivation. A summary of this work can be found below:

Community based CO risks

Commissioned ad-hoc surveys of community based CO risks can also greatly help our understanding of the surveillance of CO related health burdens.

The study ‘Carbon monoxide alarms in private homes: prevalence of potential exposure in Hackney’ was completed in 2012. This work was recently published in the Journal of Environmental and Public Health (Vol 2013, Article ID 735952 [external link])

Estimate of the burden of disease due to CO poisoning

We are designing a methodology to quantify the total burden of disease due to CO poisoning in domestic dwellings. This considers a wide range of data sources on potential exposure to carbon monoxide, including both routine data on mortality and morbidity, as well as information collected as part of the response by emergency responders to reported CO incidents. The potential burden on disease can be summarised by the Development of burden of disease population exposure estimates for accidental CO poisoning - a sysematic approach (PDF, 267 KB) summary and the burden of disease pyramid due to CO poisoning diagram below.
 

                              Burden of disease pyramid due to CO poisoning

Burden of disease pyramid due to CO poisoning

The developing environmental public health surveillance system (EPHSS) is ideally placed to track the surveillance of the CO poisoning health burden.The surveillance system will be able to capture data regarding environmental monitoring of the hazard, incidents reported, emergency services call outs and health outcomes surveillance.

The CO tracking projects will demonstrate the benefits of the EPHSS to provide information on the environmental hazard, exposures and related health outcomes.

For more information please contact the environmental public health tracking team.