Deaths Resulting from Residential Fires and the Prevalence of Smoke Alarms -- United States, 1991-1995

In 1995, residential fires accounted for an estimated 3600 deaths and approximately 18,600 injuries (1,2). In addition, property damage and other direct costs have been estimated to exceed more than $4 billion annually (3). To determine residential fire-related death rates, CDC analyzed death certificate data from 1991 to 1995 from U.S. vital statistics mortality tapes. Data from CDC's Behavioral Risk Factor Surveillance System (BRFSS) was used to determine the prevalence of smoke alarms in U.S. households. This report presents the findings of these analyses, which indicate a seasonal variation in fire-related deaths and a high prevalence of smoke alarms in residences in the United States.

Deaths from residential fires were classified using International Classification of Diseases, Ninth Revision, external cause of injury codes E890-E899 and the place of occurrence noted as residence on the death certificate. The 1995 BRFSS survey is the only comprehensive survey from which state-specific prevalence rates for smoke alarms can be generated. The BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the U.S. population aged greater than or equal to 18 years. Estimates of the prevalence of smoke alarms were weighted based on the number of telephone numbers per household and the age, sex, and race distribution in each state.

From 1991 to 1995, the U.S. residential fire-related death rate declined from 1.3 per 100,000 population to 1.1. During this time period, residential fire-related death rates were greatest during December-February and lowest during June-August (Figure_1).

The averaged annualized death rates for 1991-1995 showed that children aged less than 5 years and adults aged greater than or equal to 65 years had higher rates than those in other age groups (Figure_1). In 1995, 93.6% of households in the United States reported having at least one smoke alarm. The prevalence of smoke alarms ranged from 78.9% in Hawaii (95% confidence interval {CI}=76.7%-81.2%) to 98.7% in Maryland (95% CI=98.3%-99.1%) (Table_1).

Reported by: Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: During 1991-1995, deaths from residential fires declined, meeting the national health objective for 2000 of 1.2 per 100,000 persons (objective 9.6) (4). The findings in this report suggest that residential fire-related deaths were greatest during December-February, reflecting the seasonal use of heating devices (e.g., portable space heaters and wood-burning stoves). The leading causes of residential fires are due to cooking and heating devices improperly placed and/or left unattended (5).

Because 81% of fire-related deaths occur in the home, strategies that emphasize residential fire prevention probably will result in the largest reduction in fire-related deaths. To reduce the risk for death or injury resulting from fires, a smoke alarm should be installed outside each sleeping area and on every habitable level of a home (6). Homes with smoke alarms have almost half as many fire-related deaths compared with homes without smoke alarms (7,8). Children aged less than 5 years and adults aged greater than or equal to 65 years have two to six times higher fire-related death rates compared with the national average for all ages (2). Both young children and older adults who may have physical limitations can benefit from the early warnings provided by smoke alarms.

The findings in this report also indicate that the prevalence of smoke alarms across the United States is high. This is, in part, due to various programs, such as distribution and installation programs, conducted by state and local health departments and fire service personnel and programs that provide smoke alarms to parents of newborns (9). However, these data do not necessarily reflect the proportion of homes equipped with functional smoke alarms. The effectiveness of smoke alarms is dependent on appropriately installing and maintaining the device (1), and approximately 50% of smoke alarms are no longer functional 12 months after installation. It is necessary to continue with programs to install smoke alarms in homes to achieve 100% coverage and to implement public health programs that focus on their maintenance.

This analysis has at least one important limitation. Low-income households less likely to have telephones are probably less likely to have smoke alarms. Because the BRFSS excludes households without telephones, the prevalence of smoke alarms may be overestimated.

Effective public health strategies to reduce residential fire-related injuries and deaths should include 1) smoke alarm installation, 2) monthly testing of smoke alarms, 3) reduction of residential fire hazards, 4) the design and practice of fire escape plans, 5) fire-safety education, and 6) the implementation of smoke alarm ordinances. The adoption of these strategies should lead to continued declines in residential fire-related deaths.

References

1. Mallonee S, Istre GR, Rosenberg M, et al. Surveillance and prevention of residential-fire injuries. N Engl J Med 1996;335:27-31.

2. National Center for Health Statistics. National summary of injury mortality data, 1995. Hyattsville, Maryland: US Department of Health and Human Services, CDC, National Center for Health Statistics, 1997.

3. Karter MJ Jr. Fire loss in the United States during 1995. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 1996.

4. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1990; DHHS publication no. (PHS)91-50212.

5. Hall JR. The U.S. fire problem and overview report: leading causes and other patterns and trends. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 1998.

6. US Department of Commerce. Smoke alarm training, 1977. Washington, DC: National Fire Prevention and Control Administration, Public Education Office, 1977.

7. Ahrens M. U.S. experience with smoke detectors and other fire detectors. Quincy, Massachusetts: National Fire Protection Association, Fire Analysis and Research Division, 1997.

8. Marshall S, Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts JD. Fatal residential fires: who dies and who survives. JAMA 1998;279: 1633-7.

9. CDC. Efforts to increase smoke detector use in U.S. households: an inventory of programs. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control, 1996.

TABLE 1. Prevalence of households* with at least one smoke alarm, by state --
Behavioral Risk Factor Surveillance System, United States, 1995
======================================================================================
State             %        (95% CI+)     ş  State               %         (95% CI)
-----------------------------------------+------------------------------------------
Alabama          92.6    (91.1%-94.1%)   ş  Montana            90.1    (88.1%-92.1%)
Alaska           96.4    (94.9%-97.8%)   ş  Nebraska           90.9    (89.4%-92.4%)
Arizona          91.5    (89.6%-93.3%)   ş  Nevada             95.0    (93.8%-96.2%)
Arkansas         87.7    (85.9%-89.4%)   ş  New Hampshire      97.7    (96.9%-98.6%)
California       92.7    (90.9%-94.5%)   ş  New Jersey         96.0    (94.7%-97.3%)
Colorado         90.5    (89.0%-92.0%)   ş  New Mexico         87.6    (85.4%-89.8%)
Connecticut      96.8    (95.9%-97.8%)   ş  New York           94.5    (93.5%-95.5%)
Delaware         97.4    (96.5%-98.2%)   ş  North Carolina     93.9    (93.0%-94.9%)
Florida          92.2    (91.1%-93.2%)   ş  North Dakota       94.3    (93.0%-95.6%)
Georgia          92.9    (91.7%-93.5%)   ş  Ohio               96.7    (95.6%-97.8%)
Hawaii           78.9    (76.7%-81.2%)   ş  Oklahoma           93.2    (91.8%-94.5%)
Idaho            92.0    (90.9%-93.2%)   ş  Oregon             97.7    (97.1%-98.2%)
Illinois         97.8    (97.0%-98.6%)   ş  Pennsylvania       95.1    (94.3%-96.0%)
Indiana          95.8    (94.8%-96.7%)   ş  Rhode Isaland      95.6    (94.5%-96.7%)
Iowa             93.7    (92.8%-94.6%)   ş  South Carolina     95.8    (94.6%-97.0%)
Kansas           91.9    (90.5%-93.2%)   ş  South Dakota       88.1    (86.3%-89.8%)
Kentucky         91.9    (90.6%-93.2%)   ş  Tennessee          92.6    (91.4%-93.8%)
Louisiana        84.5    (82.6%-86.5%)   ş  Texas              87.6    (85.7%-89.5%)
Maine            96.4    (95.2%-97.7%)   ş  Utah               91.1    (89.6%-92.6%)
Maryland         98.7    (98.3%-99.1%)   ş  Vermont            95.3    (94.4%-96.3%)
Massachusetts    97.8    (97.0%-98.6%)   ş  Virgina            96.1    (95.0%-97.1%)
Michigan         96.5    (95.6%-97.3%)   ş  Washington         96.6    (95.8%-97.3%)
Minnesota        97.3    (96.6%-97.9%)   ş  West Virginia      91.7    (90.4%-92.9%)
Mississippi      85.3    (83.0%-87.5%)   ş  Wisconsin          96.9    (95.9%-97.9%)
Missouri         94.7    (93.3%-96.2%)   ş  Wyoming            90.5    (89.1%-91.8%)
-----------------------------------------+------------------------------------------
* Persons aged >= 18 years who reported the presence of at least one smoke alarm.
+ Confidence interval.
======================================================================================

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