Global, regional, and national burden of unintentional poisoning, 1990-2023: results from the Global Burden of Disease Study 2023.
BACKGROUND Unintentional poisoning is a preventable cause of injury-related morbidity and mortality, yet global patterns, trends, and inequalities remain incompletely characterised. Within the Global Burden of Disease (GBD) framework, unintentional poisoning includes poisoning by carbon monoxide and poisoning by other means, a category largely informed by pesticide poisoning codes plus some indirect capture of other poisoning as part of the GBD re-distribution process. Poisonings by pharmaceuticals and illicit substances are not captured in the GBD definition of poisoning. We aimed to quantify this GBD-defined burden and assess regional variation, sociodemographic gradients, and case fatality between 1990 and 2023. METHODS We analysed GBD 2023 estimates for 204 countries and territories, modelling deaths, incidence, and disability-adjusted life-years (DALYs) using standard GBD cause-of-death and non-fatal estimation methods with 95% uncertainty intervals. We stratified results by age, sex, region, and Socio-demographic Index (SDI), and derived case fatality from modelled deaths and incidence. FINDINGS In 2023, unintentional poisoning from carbon monoxide and other means caused 2·54 million incident poisonings, 69 805 deaths, and 3·68 million DALYs globally, with age-standardised DALY rates declining by 47·5% since 1990. Carbon monoxide accounted for 641 932 poisonings, 30 890 deaths and 1·34 million DALYs, with the highest burdens in central and eastern Europe and central Asia. Most regions showed substantial long-term declines, and the global age-standardised DALY rate for carbon monoxide poisoning declined by 58·2% since 1990. Poisoning by other means caused 1·90 million incident cases, 38 914 deaths, and 2·34 million DALYs, with the greatest burden in sub-Saharan Africa. Most regions showed declining age-standardised DALY rates for poisoning by other means; however, there was no clear change (with the 95% uncertainty interval including zero) in the global estimate, driven by wide uncertainty intervals in several regions (including sub-Saharan Africa). Mortality and DALYs were inversely associated with SDI, and derived case fatality was highest in low-SDI regions. INTERPRETATION Global reductions in GBD-defined unintentional poisoning by carbon monoxide and other means are consistent with decades of regulatory and environmental interventions. These include bans of highly toxic pesticides, improved heating and ventilation systems, emissions controls, and adoption of carbon monoxide alarms. Stark inequalities persist in some regions and in low-SDI settings. Compared with previous GBD publications, this study provides a detailed global assessment of unintentional poisoning by carbon monoxide and other means up to 2023, integrating incidence, DALYs, and comparative case fatality across regions. FUNDING Gates Foundation and the Australian National Health and Medical Research Council.