Global patterns and trends of carbon monoxide poisoning: A comprehensive spatiotemporal analysis using joinpoint regression and ARIMA modeling, 1990–2021

Abstract

Background Carbon monoxide (CO) poisoning causes approximately 41,000 deaths annually worldwide despite being preventable. Previous studies focused primarily on mortality alone, lacked systematic socio-demographic analysis, and provided no predictive models. This study comprehensively analyzes global CO poisoning patterns using spatiotemporal methods to inform evidence-based prevention strategies. Methods We analyzed Global Burden of Disease Study 2021 data from 204 countries (1990–2021) for age-standardized incidence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression identified temporal trends with statistical precision, spatial statistics quantified geographic clustering, and ARIMA modeling projected trends through 2050. We examined associations with socio-demographic index (SDI) across regions and countries. Results Global age-standardized incidence rates decreased significantly by 35.1% from 12.13 (95% UI: 8.30–17.00) to 7.87 (95% UI: 5.54–10.81) per 100,000 population (annual percentage change: −1.16%, 95% UI: −1.35% to −0.96%, p < 0.001). Mortality rates declined more dramatically by 53.9% from 0.76 (95% UI: 0.66–0.91) to 0.35 (95% UI: 0.24–0.40) per 100,000 (annual change: −2.79%, 95% UI: −3.14% to −2.44%, p < 0.001). DALY rates showed the steepest reduction of 59.5% from 37.59 (95% UI: 31.75–44.76) to 15.22 (95% UI: 10.67–17.57) per 100,000 (annual change: −3.18%, 95% UI: −3.51% to −2.84%, p < 0.001). Eastern Europe demonstrated the highest burden (37.98 per 100,000 in 2021). Males experienced significantly higher mortality than females (0.50 vs 0.20 per 100,000, p < 0.001). SDI analysis revealed an inverted U-shaped relationship (Spearman’s r = 0.76, p < 0.001), with peak burden at moderate development levels (SDI: 0.6–0.7). Conclusions These findings directly address previous research gaps by demonstrating: (1) faster mortality decline than incidence decline indicates improved global treatment capabilities; (2) the SDI-burden relationship identifies moderate-development countries as priority intervention targets; (3) significant male predominance (2.5-fold higher mortality) supports gender-specific prevention programs; and (4) persistent Eastern European hotspots require targeted infrastructure improvements. Predictive models forecast continued decline through 2050 and enable evidence-based healthcare planning. This comprehensive analysis provides the first multi-dimensional global assessment, offering crucial evidence for differentiated prevention strategies worldwide.