Trends and Demographics of Household Caustic Ingestions: Incidence over Time, Age, and Gender Variations

Introduction: Household chemical exposures commonly result in unintentional caustic ingestions, leading to severe gastrointestinal or respiratory damage. This study analyzed demographics, patient outcomes, and trends in caustic ingestions over time, focusing on differences between acids and bases, with bleach as its own category.

Methods: Using the 2004-2023 National Electronic Injury Surveillance System, poisonings by oral ingestion were identified via diagnosis and body part codes. Medications, drugs, alcohol and tobacco were excluded. Substances were categorized into acids, bases, or bleaches. Outcomes measured included sex, race, age, and disposition. Statistical analyses were performed using SPSS and R with p<.05 for significance.

Results: 6,864 total cases were identified, of which 4,033 cases were categorized into 219 acids, 1,772 bases, and 2,042 bleaches. Common ingestions were bleach (29.3%), laundry detergents (15.6%) and household cleaners (14.5%). Ingestions varied by year (p <.001), with laundry detergent spiking from 2011-2015. Patients ingesting bleach (mean age 13.1) were older than those ingesting acids (5.8) or bases (7.3, p<.001). They were also more likely to be Black (46.5%) than patients ingesting acids or bases (p <.001). Bleach ingestions were more likely to be released with or without treatment (p <.001) and less likely to be admitted or observed (p=.006, p=.019). Treatment outcomes did not differ significantly between acid and base ingestions.

Conclusions: This study found a racial disparity where patients who ingested bleach were more likely to be Black , warranting improved labeling and counseling. It also found an increase in laundry product ingestions likely relating to introduction of Tide Pods in 2012. Despite knowledge that basic ingestions cause worse injuries, basic and bleach ingestions did not have worse outcomes than acids, challenging this paradigm. This study emphasizes evolving ingestion patterns and underscores the need for public health interventions to reduce caustic exposure risks.