Risk factors for fatal residential fires

Residential fires are the most important cause of fire-related mortality in the United States. Previous research has concentrated on fatal fires in urban areas; considerably less is known about fatal fires in rural areas. We studied fatal and nonfatal residential fires in predominantly rural areas. Using a casecontrol design, we compared all 151 fatal fires (cases) in single-family dwellings in North Carolina during a 13-month period with a sample of nonfatal fires (controls). Case fires were identified through the medical-examiner system, and control fires that occurred within a few weeks of the case fires were chosen from the records of randomly selected fire departments statewide. For each fire, fire officials were interviewed about the dwelling, the fire, the people involved, and the fire-response system. Although heating incidents were the leading cause of fires, fatal fires were more likely to have been caused by smoking (31% of fatal fires vs. 6% of nonfatal fires). Mobile homes posed a higher risk of death if a fire occurred (odds ratio, 1.7; 95% confidence interval, 1.1 to 2.6), as did the absence of a smoke detector (odds ratio, 3.4; 95% confidence interval, 2.1 to 5.6). Smoke detectors were more protective against death in fires involving young children and when no one present was impaired by alcohol or drugs or had a physical or mental disability. The presence of an alcohol-impaired person was the strongest independent risk factor for death in the case of a fire (odds ratio, 7.5; 95% confidence interval, 4.4 to 12.7). In conclusion, residential fires are most likely to be caused by heating equipment or smoking materials. The risk of death is greatest in fires in mobile homes, in those involving alcoholimpaired persons, and in those in houses without smoke detectors.