Katherine Wheeler-Martin1, Sari Soghoian1, Jane M Prosser1, Alex F Manini1, Elizabeth Marker1, Marina Stajic1, David Prezant1, Lewis S Nelson1, Robert S Hoffman1. 1. Katherine Wheeler-Martin is with the New York City Department of Health and Mental Hygiene, New York, NY. Sari Soghoian is with the Division of Medical Toxicology, Department of Emergency Medicine, NYU School of Medicine, New York. Jane M. Prosser is with the Weill Cornell Medical Center, New York. Alex F. Manini is with the Mt Sinai School of Medicine, New York. Elizabeth Marker and Marina Stajic are with the Office of the Chief Medical Examiner New York City. David Prezant is with the Fire Department of New York City. Lewis S. Nelson and Robert S. Hoffman are with the New York City Poison Center.
Abstract
OBJECTIVES: We sought to evaluate the impact of New York City's (NYC's) 2004 carbon monoxide (CO) alarm legislation on CO incident detection and poisoning rates. METHODS: We compared CO poisoning deaths, hospitalizations, exposures reported to Poison Control, and fire department investigations, before and after the law for 2000 to 2010. Use of CO alarms was assessed in the 2009 NYC Community Health Survey. RESULTS: Investigations that found indoor CO levels greater than 9 parts per million increased nearly 7-fold after the law (P < .001). There were nonsignificant decreases in unintentional, nonfire-related CO poisoning hospitalization rates (P = .114) and death rates (P = .216). After we controlled for ambient temperature, the law's effect on hospitalizations remained nonsignificantly protective (incidence rate ratio = 0.747; 95% confidence interval = 0.520, 1.074). By 2009, 83% of NYC residents reported having CO alarms; only 54% also recently tested or replaced their batteries. CONCLUSIONS: Mandating CO alarms significantly increased the detection of potentially hazardous CO levels in NYC homes. Small numbers and detection bias might have limited the discovery of significant decreases in poisoning outcomes. Investigation of individual poisoning circumstances since the law might elucidate remaining gaps in awareness and proper use of CO alarms.
OBJECTIVES: We sought to evaluate the impact of New York City's (NYC's) 2004 carbon monoxide (CO) alarm legislation on CO incident detection and poisoning rates. METHODS: We compared COpoisoning deaths, hospitalizations, exposures reported to Poison Control, and fire department investigations, before and after the law for 2000 to 2010. Use of CO alarms was assessed in the 2009 NYC Community Health Survey. RESULTS: Investigations that found indoor CO levels greater than 9 parts per million increased nearly 7-fold after the law (P < .001). There were nonsignificant decreases in unintentional, nonfire-related COpoisoning hospitalization rates (P = .114) and death rates (P = .216). After we controlled for ambient temperature, the law's effect on hospitalizations remained nonsignificantly protective (incidence rate ratio = 0.747; 95% confidence interval = 0.520, 1.074). By 2009, 83% of NYC residents reported having CO alarms; only 54% also recently tested or replaced their batteries. CONCLUSIONS: Mandating CO alarms significantly increased the detection of potentially hazardous CO levels in NYC homes. Small numbers and detection bias might have limited the discovery of significant decreases in poisoning outcomes. Investigation of individual poisoning circumstances since the law might elucidate remaining gaps in awareness and proper use of CO alarms.
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