Perspectives in Disease Prevention and Health Promotion Regional Distribution of Deaths From Residential Fires -- United States, 1978- 1984

In 1984, 5,010 people in the United States lost their lives in fires; almost 90% of them died in residential fires (National Center for Health Statistics (NCHS), unpublished data). To assess the regional distribution of these deaths,* 1978-1984 mortality data collected by NCHS** were analyzed.

While an average of 4,897 persons died in residential fires each year during the period 1978-1984 (Table 1), residential fire death rates per 100,000 population decreased 21%, from 2.4 in 1978 to 1.9 in 1984 (CDC, unpublished data). The South had the largest average number of deaths per year (2,150) and the highest average death rate per 100,000 population (2.9). In contrast, the West had the lowest average number of deaths per year (585) and the lowest death rate per 100,000 population (1.4). Residential fire deaths and death rates for the Northeast and the Midwest were lower than those for the South, but higher than those for the West.

Overall, males in the South had the most residential fire deaths and the highest death rate per 100,000. The male to female ratio of residential fire death rates varied by region from 1.4 to 1.7. However, death rates for females in the South were higher than for females in other regions and higher than for males in the West.

In all regions, residential fire death rates were much higher for children aged 0-4 years and the elderly (greater than or equal to65 years) than for those aged 5-64 years; however, the rate differences were most pronounced in the South. Children had higher residential fire death rates than the elderly in the Midwest and the Northeast. However, in the South and West, residential fire death rates were lower for children than for the elderly.

For each region, deaths from conflagrations (uncontrolled fires) (E890) represented 87% to 90% of deaths from residential fires; those from clothing ignitions (E893) represented 4% to 5%; and those from other residential fires such as fires in unspecified buildings or structures (E891) and ignition from highly inflammable material (E894) represented 6% to 8%. For each type of residential fire death, the South had the highest number of deaths, and the West, the lowest. For conflagrations, the residential fire death rate was highest in the South (2.5) and lowest in the West (1.2); fire death rates were similar in the Northeast (1.7) and Midwest (1.9). For clothing ignition, the residential fire death rates were identical in all four regions (0.1). For all other residential fire deaths, the rate in the Northeast, Midwest, and West was 0.1; the rate in the South was 0.2.

Most residential fire deaths occurred in the winter (December-February), and the fewest occurred in the summer (June-August) (Figure 1). Within each region, the seasonal distribution of residential fire deaths varied markedly. In the winter, the number of deaths in every region was 1.5 to 3.3 times the number of deaths in the summer. For every season, the South had the highest number of deaths, and the West had the lowest. Reported by: Epidemiology Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial note: The week of October 4-10 marks the 65th anniversary of Fire Prevention Week (FPW), which was first observed in 1922 after President Warren Harding proclaimed a national fire prevention day to commemorate the Great Chicago Fire of 1871 (1). The Chicago fire destroyed over 17,000 buildings, killed 250 persons, and rendered 10,000 others homeless (1).

Since residential fire deaths have accounted for most deaths from fires and flames in recent years, the U.S. Department of Health and Human Services identified residential fires as an important area for intervention and established an objective to reduce the death rate from the 2.4 deaths per 100,000 recorded in 1978 to 1.5 deaths per 100,000 by 1990 (2). At the same time, the department established an objective to increase the number of functioning smoke detectors in residential homes from 30 million in 1979 to at least 110 million (75% of homes) by 1990 (2). These objectives go hand-in-hand with the aim of FPW activities--to promote fire safety and prevent fire-related injuries, deaths, and property damage.

During FPW, individual fire departments across the nation conduct additional fire safety programs for targeted populations in their areas. These programs are of two general types: preventing fires from occurring and reducing the risk of injury in the event of fire. Prevention activities focus on promoting safe storage of matches and flammable liquids such as gasoline and kerosene, teaching children not to play with matches, and discouraging people from smoking in bed. Injury risk-reduction programs teach how to install and maintain smoke detectors, how to put out fires, and how to escape during a fire.

Smoke detectors are relatively inexpensive devices designed to warn people of a fire before it becomes unmanageable and noxious gases are released. Although the effectiveness of smoke detectors has not been thoroughly evaluated, one investigator estimated that the residential fire death rate in homes with a detector was half that in homes without one (3). Possible explanations for continued residential fire deaths include the low prevalence of smoke detectors in the homes of high-risk groups and poor maintenance of smoke detectors after installation; personal characteristics such as alcohol consumption and smoking in bed; and conditions that hamper the chances of escape from a fire, such as hearing and/or visual impairment, the effect of medications, lack of mobility, or advanced age (4-7). Additional risk factors for residential fires are poverty, poor housing, and decreased availability and slower response of fire department services (7-9).

Reasons for the high rate of residential fire deaths in the South are not known because definitive studies on residential fires have not been conducted. There is, however, some evidence that, compared with other regions, the South has had a lower prevalence of smoke detectors (10), a high usage of portable heating equipment (6), and a larger percentage of persons below the poverty level (11). Together, these factors may contribute to the higher rate of residential fire deaths in the South.

The overall residential fire death rate in the West was lower than 1.5 deaths per 100,000 (the 1990 objective rate for residential fires), although children, the elderly, and males in this region had rates higher than 1.5. The overall death rates for all other regions were 27% to 93% higher than the 1990 objective, and some age-specific rates far exceeded the 1990 objective for lowering the residential fire death rate.

Most residential fire deaths occurred in the winter, followed by spring, fall, and summer. Since the risk of dying in a residential fire varies markedly by season, deaths from residential fires might be reduced if fire prevention and risk-reduction activities in each region target high-risk groups at appropriate times of the year. Residential fire death rates might be further reduced by increasing the prevalence of functioning smoke detectors in the homes of high-risk groups, by adopting safe house-heating practices, and by modifying commercial brands of cigarettes to reduce their potential to start fires on upholstered furniture or mattresses (12; National Bureau of Standards, unpublished data). The manufacture of self-extinguishing and otherwise less fire-prone cigarettes is technically feasible, according to a recent study conducted by the National Bureau of Standards (National Bureau of Standards, unpublished data).

The maintenance of functioning smoke detectors in high-risk homes will require innovative approaches. For example, to reduce fire death risks for the elderly, a public health nurse or a home health-care provider might be asked to check the condition of the smoke detector and complete a fire safety checklist as part of the medical evaluation. Further information is needed to assess the effectiveness of smoke detectors in homes of the elderly and to ascertain specific circumstances leading to residential fire deaths.

References

1. National Fire Protection Association. Develop and practice a home fire escape plan during NFPA's fire prevention week, October 4-10, 1987. Quincy, Massachusetts: National Fire Protection Association, 1987.

2. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980.

3. Hall JR Jr. A decade of detectors: measuring the effect. Fire Journal 1985;79:37-43, 78.4.(begin-ind)CDC. Prevalence of smoke detectors in private residences--DeKalb County, Georgia, 1985. MMWR 1986;35:445-8.

4. Karter MJ Jr. Patterns of fire deaths among the elderly and children in the home. Fire Journal 1986;Mar:19-22.

5. Baker SP, O'Neill B, Karpf RS. Burns and fire deaths. In: The injury fact book. Lexington, Massachusetts: Lexington Books, 1984:139-54.

6. Mierley MC, Baker SP. Fatal house fires in an urban population. JAMA 1983;249:1466-8.

7. Feck G, Baptiste MS, Tate CL Jr. An epidemiologic study of burn

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