Correspondence
Deaths and Injuries from House Fires
N Engl J Med 2001; 345:1064-1065October 4, 2001
- Article
To the Editor:
Istre et al. (June 21 issue)1 reported that 5.5 percent of house fires were caused directly by smoking and 4.5 percent by children playing with fire, which is greatly facilitated by the presence of smoking paraphernalia, such as matches and lighters, in the home. They also found that fires caused by smoking were more likely to cause injury than fires with most other causes. This is consistent with previous literature showing that cigarettes are the leading cause of lethal fires in the United States.2
However, the authors do not list smokers or their children as high-risk groups to target for programs to prevent fire-related injury. Distribution of smoke detectors is not likely to be very successful in the homes of smokers, who are likely to disable the detectors because otherwise they would be frequently set off by cigarette smoke.
Comprehensive public health measures to reduce death and injury from residential fires should include effective tobacco-control interventions. Such interventions might be particularly important now that smoking is prohibited in many public places. Fire-related injuries and deaths should be thought of as important sequelae of tobacco use in homes.3
3 ReferencesC. Andrew Aligne, M.D., M.P.H.
Pediathink, Rochester, NY 14607
aaligne1@rochester.rr. com Jeffrey J. Stoddard, M.D.
Center for Studying Health System Change, Washington, DC 20024-25121
Istre GR ,McCoy MA ,Osborn L ,Barnard JJ ,Bolton A . Deaths and injuries from house fires. N Engl J Med 2001;344:1911-1916
Full Text | Web of Science | Medline2
Ballard JE ,Koepsell TD ,Rivara F . Association of smoking and alco-hol drinking with residential fire injuries. Am J Epidemiol 1992;135:26-34
Web of Science | Medline3
Aligne CA ,Stoddard JJ . Tobacco and children: an economic evaluation of the medical effects of parental smoking. Arch Pediatr Adolesc Med 1997;151:648-653
CrossRef | Web of Science | Medline
To the Editor:
The report by Istre et al. includes no mention of alcoholism as a cause of deaths and injuries from house fires. Is alcoholism not an important contributing factor in house fires? Or is this omission yet another example of our capacity to ignore a disease that is rampant and largely avoided by the medical care system?
S. Spence Meighan, M.B., Ch.B.
408 N.W. Rainier Terr., Portland, OR 97210To the Editor:
The report by Istre et al. highlighted the increased risk of house-fire–related injury and death among the elderly and noted that cooking was involved in more than 10 percent of house fires. One household fire hazard that seems to have escaped notice is the common placement of a kitchen cabinet directly over a gas range. For example, when one elderly woman who was boiling water reached for a canister of tea in the cabinet over the range, her loose-fitting pajamas touched the open flame and then caught fire. She had burns on 50 percent of her body and died of the injury.
This particular kitchen-design feature is ubiquitous. The danger is greatest with open-flame gas ranges but is present to some degree with electric units as well. The frequency with which such burn injuries occur may be substantial. Better fire-safety requirements could prevent such injuries.
Daniel J. Pender, M.S.E., M.D.
Columbia University, New York, NY 10021Author/Editor Response
The authors reply:
To the Editor: We agree with Aligne and Stoddard that smoking is an important cause of residential-fire–related injuries. We did not list smokers or their children as high-risk groups because we could not quantify the effect of smoking on the risk of these injuries. We had no data on smoking for the households with fires that were caused by other factors, which made it difficult to evaluate the effect of smoking on the risk of injury. Nevertheless, for house fires in Dallas, smoking, matches, or lighters were involved in 10 percent of the fires, 11 percent of the nonfatal injuries, and 22 percent of the deaths. Ballard et al.,1 Mierley and Baker,2 and Runyan et al.3 showed that smoking was an important cause of residential-fire–related deaths and injuries; some of these might be prevented with the development of fire-safe cigarettes. Preventing fires and injuries caused by children playing with matches and lighters may be more difficult.4
Our report, as pointed out by Meighan, did not mention alcohol for similar reasons. We had no information about alcohol use in nonfatal injuries or in persons who were present but not injured during house fires. Runyan et al.3 and Marshall et al.5 showed that alcohol use was a risk factor for residential-fire–related deaths and injuries. We had data on alcohol use only for persons who died. Of the 38 fatally injured adults for whom alcohol levels were obtained, 11 (29 percent) had detectable blood alcohol levels at autopsy; 9 of these (24 percent) were legally intoxicated. With no data available to us on alco-hol use in nonfatal injuries and noninjured persons, we could not quantify the relative risk associated with alco-hol use.
Although we could not estimate the magnitude of the impact of alcohol and tobacco use on residential-fire–related injuries, our data nevertheless support the assertion that these products play an important part in the occurrence of such injuries. Efforts that decrease alcohol and tobacco use would probably result in fewer deaths and injuries from house fires.
Pender's observation warrants further study. In our data set, kitchen fires resulted in injuries less often than fires that started in a bedroom or living area, and the injuries tended to be less severe. The rate of death from kitchen fires in Dallas was about one third the rate of death from fires that started in a bedroom or living area.
5 ReferencesGregory R. Istre, M.D.
Mary A. McCoy, B.S.
Injury Prevention Center of Greater Dallas, Dallas, TX 75235Jeffrey J. Barnard, M.D.
Dallas County Medical Examiners Office, Dallas, TX 752351
Ballard JE ,Koepsell TD ,Rivara F . Association of smoking and alco-hol drinking with residential fire injuries. Am J Epidemiol 1992;135:26-34
Web of Science | Medline2
Mierley MC ,Baker SP . Fatal house fires in an urban population. JAMA 1983;249:1466-1468
CrossRef | Web of Science | Medline3
Runyan CW ,Bangdiwala SI ,Linzer MA ,Sacks JJ ,Butts J . Risk factors for fatal residential fires. N Engl J Med 1992;327:859-863
Full Text | Web of Science | Medline4
Hall JR Jr. Children playing with fire. Quincy, Mass.: National Fire Prevention Association, June 2001. (Report no. USS17.)
5
Marshall SW ,Runyan CW ,Bangdiwala SI ,Linzer MA ,Sacks JJ ,Butts JD . Fatal residential fires: who dies and who survives? JAMA 1998;279:1633-1637
CrossRef | Web of Science | Medline
