Firefighter Fatalities: Crude Mortality Rates and Risk Factors for Line of Duty Injury and Death.

The United States Fire Administration (USFA) provides high-quality data for firefighter deaths (FFDs), but until now these data have not been analyzed for temporal trends. This analysis explores FFDs between 1990 and 2016 to determine high-risk groups for outreach and training. Mortality rates were calculated using USFA information compared against the total number of deaths per year. Rates were compared between 1990-2009 (early period) and 2010-2016 (recent period). Multinomial logistic regression was used to determine predictors of death in firefighters (FFs) by age group (≤45 and >45 years old) and by work status (career vs volunteer). Analysis of 3159 FFDs revealed a decline in crude-rate mortality between 1990-2009 and 2010-2016 (47.4 vs 35 FF deaths per million, P < .0001). FFs of ≤45 years old were less likely to die in the 2010s than in the 1990s-2000s (13.7 vs 24.7 FF deaths per million, P = .0002). Trauma-related deaths decreased (13.1 vs 8.1, P = .0003), whereas CV-related deaths remained constant (19.4 vs 19.5, P = .24). Regression analysis determined that volunteer FFs were more likely to die from burns (OR 1.7, CI: 1.2-2.4, P < .0001) and trauma (OR 1.8, CI: 1.5-2.2, P < .0001) than career FFs. Younger FFs were also more likely to die from burns (OR 10.4, CI: 6.9-15.6, P < .0001) and trauma (OR 6.5, CI: 5.4-7.8, P < .0001). Although overall FFDs were lower after 2010, younger and volunteer FFs saw an increase in burn and trauma-related mortality. Cardiovascular-related fatalities were consistent throughout the study. Future research should continue to make use of high-standard data to track FFDs and efficacy of interventions.