Smoke alarms and residential fire mortality in the United States: an ecologic study
Introduction
Death and injury from residential fires remains a major public health challenge in the United States (US). A residential fire occurs every 70 s and a US resident dies almost every 2 h due to fire-related injuries [1] and children under 5 years of age and adults over 60 are disproportionately affected [2], [3]. In 1995 alone, over 3600 individuals were killed in residential fires and an additional 18,600 injured [1]. Besides the enormous human costs associated with these events, property damage and other direct costs have been estimated to exceed more than 4 billion dollars annually [1].
To reduce the risk of death or injury from residential fires, operable smoke alarms on every level of the home provide the residents of a burning home with sufficient advance warning for escape for nearly all types of fires [4]. Approximately 42% of fatal residential fires occur in homes without smoke alarms and the likelihood of a fatal residential fire is almost halved in homes, which have a smoke alarm [4]. Poor or low-income people are less likely than others to live in homes with smoke alarms and are also most vulnerable to fire injury and death [5], [6].
In a study of fatal and nonfatal residential fires conducted over a 13-month period, investigators found that smoke alarms provided adequate warning and protection against death in fires involving young children and when no one present was impaired by alcohol or drugs or had a physical or mental disability [7]. The study also found that 77% of the fatal fires and 50% of the nonfatal fires during the study period occurred in houses with no smoke alarms.
Fire detection devices namely, heat detectors and smoke alarms have been available for purchase by homeowners as early as 1955 [8]. In research undertaken in 1976 only 11% of heat detectors were found to provide adequate warning to ensure safe evacuation of the home whereas smoke alarms were reported to provide adequate warning in 89% of the experiments [9]. With rapidly improving smoke alarm technology and consistently positive findings from smoke alarm experiments [8], organizations in the US such as the National Fire Protection Association and the Centers for Disease Control and Prevention have been strong advocates for the use of smoke alarms in households on the basis they are effective safety devices that can reduce the risk of death from residential fires.
The prevalence of smoke alarms in homes across the US has increased steadily over the past three decades from a prevalence of 22% in 1975 [4] to 93.6% in 1995 [5]. The increased prevalence is a result of a combination of programs, including public education; legislation; improved technology; and smoke-alarm-giveaway programs. For example, over the past 5 years the Centers for Disease Control and Prevention (CDC), along with other agencies have funded many state-based smoke-alarm-giveaway programs. These programs have been designed to increase the prevalence of smoke alarms in high-risk communities namely, in low socioeconomic households and minority communities.
Although analytic studies have reported the value of smoke alarms in reducing residential fire-related morbidity and mortality [6], [7], only a few studies have considered the ecologic effect of smoke alarms [10], [11]. Given the current prevalence of smoke alarms in the community and the fact that population-based smoke alarm interventions continue to target ‘at-risk’ communities, it is timely to undertake a study to determine whether there is an ecologic association between smoke alarms and residential fire mortality. This study, which adopts an ecologic research design, is appropriate for an investigation of residential fire mortality due to the inter-relationship between smoke alarms and the social, environmental and economic factors in residential fire-related deaths and injury.
Section snippets
Methods
A multiple-group analytic design was used to assess the ecologic association between the prevalence of smoke alarms and residential fire-related mortality in the US. Two levels of ecologic data namely, individual- (weighted average for individuals within the group) and group- or state-level, were collected from a number of sources.
Results
The 50 US states and the District of Columbia were grouped into tertiles based on the aggregated (1984–1995) age standardized mortality rates for residential fires. The distribution of these rates along with the prevalence of smoke alarms for each state is described in Table 1. The average age standardized mortality rate over the observational period was 1.61 per 100,000 (95% CI=1.59–1.63). The age standardized rates ranged from a high of 3.98 per 100,000 (95% CI=3.81–4.24) in the State of
Discussion
Many individual-level studies have reported associations between smoke alarms and residential fire mortality [6], [7]. A recent study by Marshall et al. [6] found that a functioning smoke alarm reduced an individual's risk of death in a residential fire by up to 60% (OR=0.39, 95% CI=0.18–0.83). A similar study reported an increased likelihood of fire fatality in the absence of a smoke alarm [7]. Until now, no North American study had investigated whether the association between smoke alarms and
Acknowledgments
Part of this work was completed while the lead author was employed with the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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