title: Self-reported neurological symptoms in relation to CO emissions due to problem gas appliance installations in London: a cross-sectional survey.
abstract: BACKGROUND
  Previous research by the authors found evidence that up to 10% of particular household categories may be exposed to elevated carbon monoxide (CO) concentrations from poor quality gas appliance installations. The literature suggests certain neurological symptoms are linked to exposure to low levels of CO. This paper addresses the hypothesis that certain self-reported neurological symptoms experienced by a householder are linked to an estimate of their CO exposure.
  
  
  METHODS
  Between 27 April and 27 June 2006, 597 homes with a mains supply of natural gas were surveyed, mainly in old, urban areas of London. Qualified gas engineers tested all gas appliances (cooker, boiler, gas fire, and water heater) and reported, according to the Gas Industry Unsafe Situations Procedure, appliances considered At Risk (AR), Immediately Dangerous (ID) or Not to Current Standards (NCS). Five exposure risk categories were defined based on measurement of CO emitted by the appliance, its features and its use, with "high or very high" exposure category where occupants were considered likely to be exposed to levels greater than 26 ppm for one hour. The prevalence of symptoms at each level of exposure was compared with that at lowest level of exposure.
  
  
  RESULTS
  Of the households, 6% were assessed as having a "high or very high" risk of exposure to CO. Of the individuals, 9% reported at least one neurological symptom. There was a statistically significant association between "high or very high" exposure risk to CO and self-reported symptoms compared to "no exposure" likelihood, for households not in receipt of benefit, controlling for "number of residents" and presence of pensioners, OR = 3.23 (95%CI: 1.28, 8.15). Risk ratios across all categories of exposure likelihood indicate a dose-response pattern. Those households in receipt of benefit showed no dose-response pattern.
  
  
  CONCLUSIONS
  This study found an association between risk of CO exposure at low concentration, and prevalence of self-reported neurological symptoms in the community for those households not in receipt of benefit. As health status was self-reported, this association requires further investigation.
authors.affiliation: Bartlett School of Graduate Studies, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK. b.croxford@ucl.ac.uk
authors.forename: Ben
authors.initials: B
authors.lastname: Croxford
authors.forename: Giovanni S
authors.initials: GS
authors.lastname: Leonardi
authors.forename: Irene
authors.initials: I
authors.lastname: Kreis
mesh_terms: D002248:Carbon Monoxide / Q000008:administration & dosage / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D004868:Equipment Failure; D005579:Fossil Fuels / Q000009:adverse effects*; D006794:Household Articles; D006801:Humans; D016015:Logistic Models; D008131:London / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000503:physiopathology; D016017:Odds Ratio; D018570:Risk Assessment
chemical_list: D005579:Fossil Fuels; D002248:Carbon Monoxide