PONE-D-25-08215Global Patterns and Trends of Carbon Monoxide Poisoning: A Systematic Analysis from 1990 to 2021PLOS ONE

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Additional Editor Comments:

Dear authors,

Thank you for submitting your manuscript to our journal. It has now been peer-reviewed, and I agree with the comprehensive comments provided by both reviewers. We kindly ask that you address their feedback and submit a revised version for our further consideration.

Thank you,

Antonio

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1. Title is concise and should contain the name of the main used analytical methods or the limitations solving

2. The abstract needs to be reorganized firstly to clarify the main aim of your study to overcome the limitations of the previous studies in the same line with your research.

3. What are the validity of the used analytical methods main advantages and disadvantages and why such methods were applied (joinpoint regression, spatial statistics, and ARIMA modeling).

4. Abstract can’t stand alone. All results were mentioned in very concise manner that not clear for authors and the conclusive words not satisfactory about your obtained results versus your study aim.

5. Keywords not representative for your study aim or methods or analysis

6. More reviewing data about the CO poisoning are required in the section of introduction. What is the main health problems reported from exposure to CO and how exposure occur?

7. Line 63 lesions not satisfactory for the side effects of HFM replace with renal damage or renal toxicity from pesticide exposure.

8. Material and methods section: ethical approval code must be supplied in such section not at the end of the manuscript

9. Not all the obtained data were fully discussed. Discussion are very concise

10. Conclusion is so concise not presenting the study results or significance

11. All the abbreviations must be mentioned in full name for the first time and list of abbreviations should be supplied

12. Grammatical errors, has major grammatical and structural errors. Please, double-check. English must be improved and certified.

Reviewer #2: Recommendation: Minor Revision

General Comments

This manuscript presents a comprehensive and methodologically rigorous analysis of the global burden of acute carbon monoxide (CO) poisoning using data from the GBD 2021 study. The Discussion section is particularly well-developed, integrating key findings with socio-demographic insights and regional disparities. It adds value by addressing gender differences, projecting future trends, and offering policy implications.

The paper is timely and relevant for global health policy, environmental epidemiology, and injury prevention fields.

Strengths

�Clear articulation of global trends in CO burden (incidence, mortality, DALYs).

�Integration of socio-demographic index (SDI) as a framework enhances interpretability.

�Thoughtful consideration of gender-specific trends and regional disparities.

�Well-grounded policy recommendations and recognition of forecast uncertainty.

�Transparent acknowledgement of data limitations and methodological constraints.

Minor Revisions Requested

Reduce Repetition of Quantitative Results

The Discussion section occasionally reiterates specific incidence and mortality figures already presented in the Results. Consider summarizing trends without repeating exact numbers.

Expand Policy Examples

Strengthen the applicability of policy suggestions by referencing concrete measures (e.g., mandatory CO detectors in homes, national surveillance programs in Eastern Europe or Canada).

Consider Behavioral and Climate Factors

Briefly address how climate change and seasonal factors may affect CO poisoning trends.

Include a sentence on the potential impact of behavioral interventions (e.g., public education, alarm usage).

Clarify Forecasting Limitations

While limitations are mentioned, highlight the potential variability due to emerging technologies or policy shifts (e.g., clean energy transitions, urbanization).

Conclusion

This is a strong manuscript with high public health relevance and rich global insights. Minor editorial and content refinements will further improve clarity and impact. Once revised, it will make a valuable contribution to the literature on environmental health and injury epidemiology.

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Reviewer #1: No

Reviewer #2: Yes:  Dr. Kwabena Acheampong

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Attachments

Attachment

Submitted filename: Review report Plos one.docx

Attachment

Submitted filename: PONE-D-25-08215_reviewed.pdf

Attachment

Submitted filename: Global Patterns and Trends of Carbon Monoxide Poisoning.docx

Global Patterns and Trends of Carbon Monoxide Poisoning: A Comprehensive Spatiotemporal Analysis Using Joinpoint Regression and ARIMA Modeling, 1990-2021

PONE-D-25-08215R1

Dear Dr. Wang,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Antonio Peña-Fernández, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear authors,

Thank you for submitting a revised version of your manuscript. The reviewers are happy with your amended version. Therefore I recommend its publication in our journal.

Best wishes,

Antonio

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Review Recommendation Letter to the Authors

Dear Authors,

I have carefully reviewed the revised version of your manuscript titled:

“Global Patterns and Trends of Carbon Monoxide Poisoning: A Comprehensive Spatiotemporal Analysis Using Joinpoint Regression and ARIMA Modeling, 1990–2021.”

I would like to commend you for the considerable effort you invested in addressing all the comments and suggestions provided during the initial peer review. Your responses were detailed, thoughtful, and clearly reflected a strong commitment to improving the clarity, methodological soundness, and scientific value of the manuscript.

In particular, the enhanced explanations of your analytical approaches—especially the use of Joinpoint regression and ARIMA modeling—have improved the manuscript’s transparency and strengthened its contribution to the field. The updates to the discussion and interpretation of findings have also significantly improved the contextual understanding and global relevance of your study.

Your work provides a valuable and timely contribution to the global discourse on carbon monoxide poisoning trends and has important implications for public health surveillance and policy formulation.

Based on the thoroughness of your revision and the scientific merit of the study, I am pleased to recommend the manuscript for acceptance in its current form.

Congratulations on your excellent work.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #2: Yes:  Dr. Kwabena Acheampong

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