Gender-specific lethality due to carbon monoxide poisoning in Morocco

The objective of this study is to assess trends in death cases caused by carbon monoxide poisoning and to determine the possible reasons for a risk predisposition for a given sex in the event of a possible trend. In doing so, professionals working in the field of prevention take into account in control programs. Methods: Study of the regional and national evolution of sex-specific lethalities due to carbon monoxide poisoning based on deaths reported by the Anti-poison Center and Pharmacovigilance (CAPM) in the 16 regions for the period 1999-2013. Results: The chronological evolution of case-specific mortality rates on the whole shows an increasing trend for both sexes, which is in perfect proportion with the growth of deaths reported because of CO in the different regions. However, the values for the male, whose average for the period studied is 1.106%, are larger than those for females, whose average is only 0.618%. This more masculine tendency of lethalities cannot obviously be attributed to sex, nor to the particularities of deadly human CO exposure since all deaths are accidental and not related to socio-professional characteristics. Conclusion: The fatal risk in case of CO intoxication seems to favor a rather masculine superiority. This difference in lethality is simply explained by differences in the frequencies of poisoning and their fatal evolutions. Indeed, the quotient would be more masculine since the deaths due to the CO are practically similar for both sexes, whereas the frequency of the intoxications is more feminine.


Introduction
The number of carbon monoxide (CO) poisoning cases and the resulting deaths highlight the importance of this health problem in Morocco. In fact, the epidemiological surveillance carried out by the CAPM and the prevention strategies resulting from it do not seem to reduce the occurrence of poisonings and deaths, which are nevertheless preventable [1][2][3][4][5].
The historical review of the death declarations received by the CAPM, from its creation in 1980 until 2013, shows, on the one hand, the unintentional aspect of the occurrence of CO poisoning because, since 1992, the date of the first notifications, out of 211 death cases, only one case in 1995 was suicidal. On the other hand, 88% of deaths were reported from the year 2000 (185 cases) because the Toxicovigilance and Toxicological Information systems have matured much more over the years [4,5].
This study is a comparative evaluation of the specific lethalities to the two sexes, from the cases of poisoning and death cases due to poisoning by CO that reached the CAPM during a period of 15 years from 1999 to 2013, to through the annual and regional monitoring of variations in these indicators. This is done in the hope of contributing to better understanding the characteristics of CO poisoning in Morocco for better programming of the fight against this pathology.
The spatio-temporal analysis of male-specific lethalities (MSL) and female-specific lethalities (FLS) resulting from CO poisoning and as a means of measuring health, is based on the filtration of cases of death occurring between 1999 and 2013 listed in the CAPM's exhaustive database formed from its information systems: Toxicovigilance and Toxicological Information.
The analysis and the use of the data were conducted by Epi-Info and Excel software and for the cartographic visualization of the regional distribution of the indicators were examined, and the Geographic Information System was used.
Male-specific and female-specific lethalities are determined in terms of the percentages that express the number of death cases caused by intoxication, for one sex, in comparison to the number of new intoxicated cases of the same sex, during a year time. Also, the results showed that the occurrence of deaths is totally accidental, but yet seasonal. In fact, 52.76% of cases are observed in winter and 29.45 in Autumn. This is confirmed by the monthly distribution which shows a maximum of 21.08% of cases recorded during the month of December, followed by the months of February with 19.46% and January with 17.84%.

The incrimination of CO in poisoning and in death cases in Morocco has already been demonstrated by reports from the CAPM and scientific studies in
Moreover, the distribution of deaths according to the environment and the place of poisoning demonstrates that they occur for the mainly in urban areas, i.e. 78.74% of cases, and at home in 95.51% of cases. The male/female ratio shows a sex ratio for deaths of 0.91, slightly in favor of the female sex. With regard to the age of the deceased, adults constitute the majority with 69.36% of cases.
To analyze the annual change in male-specific and female-specific lethalities from CO poisoning at the regional level, the period 1999-2013 is subdivided into three-year intervals. Thus, Tables 1 and 2 Figure 1 and Table 3. The evolution over this period and space of sex-specific lethalities in Morocco therefore shows that the risk of death from CO poisoning targets both sexes [5]. However, rates for males appear to be higher at both regionally and nationally. This male severity of CO poisoning obviously cannot be related to sex because men and women have identical distribution of health condition and welfare. Moreover, there are no sociological or professional specificities that could explain this disparity. However, the review of the evolution of the frequencies of poisoning and deaths due to CO, illustrated by figures 4 and 5, shows a female superiority of the number of intoxicated people during the entire period examined with a sex ratio of 0.48 [4] whereas the deaths show generally a similarity in number between the two sexes with a sex ratio for the period studied of 0.94 [5]. Put differently, the specific lethality which is the quotient between the two values will be more serious for the male sex. However, these results above do not suggest in any way possible that this is a universal phenomenon unless one verifies the gender-specific lethality trends of CO poisoning in other countries. On the contrary, the accidental nature of death which can target either sex at random cannot be overlooked.

Conclusion
The fatal effects increasing over time of carbon monoxide poisoning induce a serious public health problem in Morocco. This increase in death cases which is entirely due to accidental occurrences shows overall plausibility in number between the male and female sex compared to the frequency of poisoning which was E3S Web of Conferences 319, 02018 (2021) VIGISAN 2021 https://doi.org/10.1051/e3sconf/202131902018 always more important in time and space for the female sex. This generates lethalities specific to the male sex which are generally greater at both regional and national levels.
The seriousness of carbon monoxide, regardless of being preventable, promotes more reactivity of the CAPM through its awareness campaigns to defeat this quotient which spares no age and no gender.