Jiahao Xie,1,2,* Chengen Wu,1,2,* Zhenpeng Zhao,1,2,* Zhihua Cao,3,* Xiaoqing Jin1,* 

1Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China; 2The second Clinical School, Wuhan University, Wuhan, Hubei, 430071, People’s Republic of China; 3Department of Neurology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei, 441000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Zhihua Cao, Department of Neurology, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, 15 Jiefang Road, Fancheng District, Xiangyang, Hubei, 441000, People’s Republic of China, Email 76772446@qq.com Xiaoqing Jin, Emergency Center, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, People’s Republic of China, Email redjin@whu.edu.cn

Background: Carbon monoxide (CO) poisoning represents a significant contributor to injury burden across Asia. This study seeks to assess the burden of CO poisoning in Asia from 1990 to 2021 utilizing data from the Global Burden of Disease Study (GBD) 2021.
Methods: Data on the burden of CO poisoning across 49 Asian countries were extracted from GBD 2021. The variations in burden were analyzed according to year, gender, , age, and Socio-Demographic Index (SDI). Analyses included Joinpoint analysis to evaluate temporal trends, the age-period-cohort model to assess disease burden trends, the slope index of inequality and concentration index for assessing health disparities, frontier analysis for estimating potential outcomes based on developmental stages, and the auto-regressive integrated moving average model to predict the disability-adjusted life year (DALY) rates.
Results: During 1990– 2021, the age-standardized incidence rate (average annual percent change (AAPC) = − 0.83, 95% CI: − 0.94 to − 0.73), age-standardized mortality rate (AAPC = − 2.01, 95% CI: − 2.20 to − 1.81), and DALY rates (AAPC = − 2.39, 95% CI: − 2.54 to − 2.23) for CO poisoning across Asia declined. In 2021, females experienced a lower burden than males, and countries in higher latitudes bore a greater burden. The burden was more pronounced in extreme age groups, with an elevated cohort risk in the 1967– 1971 birth cohort (relative risk (RR) = 1.045, 95% CI: 0.96– 1.14). Health inequality analyses showed a reduction in disparities between countries with varying SDI levels. Frontier analysis identified potential improvements in reducing the burden across different countries. However, there was no notable correlation between this burden and SDI levels. The age-standardized disability-adjusted life year rate is predicted to continue declining from 2022 to 2030.
Conclusion: This study analyzes the burden of CO poisoning in Asia, revealing a decline from 1990 to 2021, with variations across countries and higher burdens in males and extreme age groups. It suggests a reduction in health inequalities and forecasts a continued decline in the burden by 2030.

Keywords: carbon monoxide poisoning, burden, trends, age-period-cohort, socio-demographic index, arima prediction