Perspectives in Disease Prevention and Health Promotion Fire- and Burn-Associated Deaths -- Georgia, 1979-1981

In 1983, the Georgia Department of Human Resources' Office of Epidemiology reviewed vital statistics data for 1979-1981 to better define the problem of unintentional, burn-associated mortality. Under the International Classification of Diseases, 9th Revision (ICD-9), unintentional thermal and chemical burns as external causes of death are specifically coded to "Accidents caused by fire and flames" (ICD-9 rubrics E890-899) and "Accidents caused by hot substance or object, caustic or corrosive material, and steam" (ICD-9 rubric E924).

During the 3-year study period, 731 deaths with underlying causes attributed to ICD-9 codes E890-899 and E924 occurred, indicating an average annual death rate of 4.46/100,000 residents based on Georgia's 1980 census population. By race, 49% of deaths occurred among whites and 51% among blacks; none occurred among other races. Decedents were male in 66% of all cases; 69% of whites were males, and 62% of blacks were males. The annual death rate was 2.1 times greater for males than for females and 2.8 times greater for blacks than for whites (Figure 1). The increased relative risk for males was characteristic of both racial groups, and the increased risk for blacks was characteristic of both sexes.

By type of burning event, more than 80% of deaths were attributed to uncontrolled fires in private residences (Table 1). Males dominated in all five cause categories, accounting for from 57% of victims of clothing fires to 85% of victims of "other conflagrations." Blacks accounted for 26% of the 53 victims of "other and unspecified fires" but from 50% to 58% of victims in the other four categories. Of the 19 deaths from hot or caustic substances, 16 (84%) were specifically coded to hot liquids and vapors, as opposed to other substances or surfaces.

Age data available for 1980-1981 indicated that approximately 22% of the 510 fatal burn victims were less than 20 years of age; 48% were 20-64 years old; and 30% were 65 years of age or older. The distribution of deaths by age varied with the type of causative event. The proportion of victims aged 65 years of age or older, for instance, ranged from about 25% for residential fires to 67% for hot substance and chemical burns. Children under 10 years of age accounted for 22% of deaths from residential fires and for 1% of all other types of burn-associated deaths. Although more burn-associated deaths occurred in the 20- to 64-year age group than in older or younger age groups, age-specific death rates were higher in the under-10 and 65-and-older age groups.

Age-specific rates were similar in pattern for both sexes and both races (Table 2) but were higher among blacks than among whites at both extremes of age and higher among males than among females for adults of both racial groups. All seven victims under 1 year of age were black; six of these were female; and all seven died from residential fires. The pattern of race-, sex-, and age-specific death rates from residential fires was similar to that for all burn-associated deaths, with rates reaching 19.3 for black female infants; 15.5 for black females and 16.1 for black males aged 1-4 years; and 16.4 for black females and 64.9 for black males aged 75 years or older. Rates were 5.5 at ages 1-4 and 8.6 at 75 years or older for white males and 4.4 at ages 1-4 and 5.1 at 75 years or older for white females. Deaths were rare among children in the other categories of burn events, where numbers of deaths generally were small. Among adults, rates generally increased markedly with advanced age among blacks and males, but specific patterns varied between race, sex, and cause groupings. Reported by TW McKinley, MPH, RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human Resources; Div of Field Svcs, Epidemiology Program Office, Special Studies Br, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Each year in the United States, unintentional burns account for some 6,000 deaths (1) and 106,000 hospitalizations (2). The crude mortality rate of 4.46/100,000 for Georgia is higher than the national rates of 2.8 for 1978 and 2.4 estimated for 1980, as reported by the National Safety Council (1). This difference is consistent with relatively higher burn-associated death rates for southern areas of the United States, as noted a decade ago (3), and may reflect regional population differences in age, race, economic, and residential characteristics--factors shown to influence burn-associated mortality rates (3,4). Mortality data reflect only a small portion of the total burn problem, since incidence rates reported for nonfatal, burn-associated injuries have ranged from 27 (4) to 150 (3) per 100,000 per year, based on hospital admissions and health survey data, respectively.

The distributions of persons and risks by age, sex, and race, along with the dominance of house fires as a causative event, are consistent with burn-associated mortality patterns reported earlier in national and New York State studies (3,4). Greater severity of injuries associated with house fires than with other burn causes, as well as relatively increased dependency and frailty among persons at the extremes of age, may explain the age patterns. A relatively higher degree of risk-taking behavior in males than in females, including such fire-causing activities as smoking (4,5) and careless handling of flammable materials (3,4), may account for the differences. Occupational hazards may also contribute to increased risks for adult males. The higher relative risks for blacks are likely to reflect socioeconomic differences. Although a threefold excess morbidity risk was found for blacks in the New York study, differences in income and education levels significantly contributed to county-specific differences in morbidity rates, while other variables did not (4). House-fire deaths in Baltimore showed a strong correlation with economic status for both whites and blacks (5).

Further studies are needed to determine which of the observed burn-associated deaths might be preventable through greater use of currently available environmental or technologic measures, such as residential smoke and fire alarms (4,5), flame-retardant materials for building construction and furniture upholstery (4), self-extinguishing matches and cigarettes (4-6), and lower temperature settings on water heater thermostats (6,7); through increased occupational safety measures; or through educational or other behavioral change activities. Since over 80% of Georgia's burn deaths occurred in home fires, significant decreases in annual mortality might be achieved through programs designed to direct specific preventive measures toward families at high risk.

All the potential intervention measures suggested above are appropriate for reducing mortality. Those based on environmental changes rather than changes in personal behavior are more direct, however, and are considered more likely to succeed (6). Such measures, which include installing residential smoke detectors and reducing temperature settings of water heaters are appropriate for immediate state and local intervention efforts and have been recommended as part of community injury-prevention programs (8).

References

1. National Safety Council. Accident facts, 1981 edition. Chicago, Illinois: National Safety Council, 1981.

2. National Center for Health Statistics. Inpatient utilization of short-stay hospitals by diagnosis: United States, l980. Hyattsville, Maryland: National Center for Health Statistics, 1983; DHHS publication no. (PHS)83-1734.(Vital and health statistics; series 13; no. 74).

3. Iskrant AP. Statistics and epidemiology of burns. Bull NY Acad Med 1967;43:636-45.

4. Feck G, Baptiste MS, Tate CL Jr. An epidemiologic study of burn injuries and strategies for prevention. Atlanta, Georgia: U.S. Department of Health, Education, and Welfare, Public Health Service, Centers for Disease Control, January 1978.

5. Mierley MC, Baker SP. Fatal house fires in an urban population. JAMA 1983;249:1466-8.

6. Teret JD, Baker SP, Trinkoff AM, DeFrancesco S. Report of the National Conference on Injury Control, May 18-19, l981. Atlanta, Georgia: Centers for Disease Control, 1981.

7. Baptiste MS, Feck G. Preventing tap water burns. Am J Public Health 1980;70:727-9.

8. CDC. Injury control initiative overview. Atlanta, Georgia: Environmental Health Services Division, Center for Environmental Health, Centers for Disease Control, 1982.

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