title: Impact of Mandatory Carbon Monoxide Alarms: An Investigation of the Effects on Detection and Poisoning Rates in New York City.
abstract: OBJECTIVE
  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.
authors.affiliation: 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.
authors.forename: Katherine
authors.initials: K
authors.lastname: Wheeler-Martin
authors.affiliation: 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.
authors.forename: Sari
authors.initials: S
authors.lastname: Soghoian
authors.affiliation: 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.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Prosser
authors.affiliation: 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.
authors.forename: Alex F
authors.initials: AF
authors.lastname: Manini
authors.affiliation: 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.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Marker
authors.affiliation: 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.
authors.forename: Marina
authors.initials: M
authors.lastname: Stajic
authors.affiliation: 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.
authors.forename: David
authors.initials: D
authors.lastname: Prezant
authors.affiliation: 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.
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
authors.affiliation: 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.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
mesh_terms: D002248:Carbon Monoxide / Q000032:analysis; D002249:Carbon Monoxide Poisoning / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D037141:Mandatory Programs / Q000331:legislation & jurisprudence; D009519:New York City / Q000453:epidemiology; D011482:Protective Devices / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D002248:Carbon Monoxide