Carbon monoxide (CO) poisoning presents with a high rate of mortality, or at least significant rate of morbidity. The consequences of non-lethal CO poisoning are similar to traumatic brain injury both in terms of some symptoms of acute injury, as well as well as concomitant delayed neurodegenerative changes. As I research the science of CO poisoning, I am struck by the body of literature that is dominated by Asian authors and Asian institutions.
I intuitively considered socio-economic disparities; the increased rural areas; and more primitive heating technology as among the most probable reasons that Asia dominates the number of scientific papers covering carbon monoxide (CO) poisoning as compared to Western regions. Having dug a bit deeper, we can elucidate the topic by considering these factors:
- Higher Incidence and Mortality Rates: Many Asian countries, particularly China and Japan, report high incidence and mortality rates of CO poisoning. For instance, Japan sees about 2000–5000 deaths annually due to CO poisoning, which is over half of the total number of poisoning deaths in the country. Similarly, China faces significant challenges with CO poisoning, especially in northern regions where coal is commonly used for heating during winter.
- Environmental and Climatic Factors: The climatic conditions in many parts of Asia, such as long and cold winters, necessitate the use of indoor heating systems, which can lead to higher risks of CO poisoning. Inadequate maintenance of heating equipment and poor ventilation further exacerbate this issue.
- Urbanization and Socioeconomic Factors: Rapid urbanization and economic disparities in Asian countries contribute to the prevalence of CO poisoning. Urban residents often rely less on coal for heating, compared to rural residents, but the overall prevalence remains high due to the large rural population. Additionally, socioeconomic factors such as the use of unsafe heating and cooking appliances in lower-income households increase the risk of CO exposure.
- Public Health Concerns and Research Focus: Given the significant public health burden posed by CO poisoning in Asia, there is a strong focus on research to understand its epidemiology, risk factors, and prevention strategies. This has led to a higher number of scientific studies and publications from the region.
- Contrast with the United States: The United States also experiences a significant incidence of CO poisoning. In 2022, the U.S. experienced 1244 deaths from CO poisoning, 47% of which were suicides. In addition, more than 100,000 Americans visit emergency rooms each year with unintentional CO poisoning. Such incidents can be caused by gasoline-powered motor vehicles, small engines, stoves, grills, fireplaces, and furnaces, not to mention portable indoor heaters. The risk of CO poisoning can be reduced with the use of CO detectors; regularly servicing gas, coal, and oil-burning appliances; and ensuring that all such equipment is adequately ventilated.
The higher number of scientific papers on CO poisoning from Asia is driven by the region’s higher incidence and mortality rates, environmental and climatic conditions, socioeconomic factors, public health priorities, and strong institutional support for research. However, the United States also has areas where environmental and socioeconomic factors often necessitate use of less reliable heating equipment and where secondary CO producing equipment is routinely used.
Stewart M. Casper
Casper & de Toledo LLC
