Introduction: Fire-related fatalities and injuries have become a growing governmental concern in Sweden, and a national vision zero strategy has been adopted stating that nobody should get killed or seriously injured from fires. There is considerable uncertainty, however, regarding the numbers of both deaths and injuries due to fires. Different national sources present different numbers, even on deaths, which obstructs reliable surveillance of the problem over time. We assume the situation is similar in other countries. This study seeks to assess the true number of fire-related deaths in Sweden by combining sources, and to verify the coverage of each individual source. By doing so, we also wish to demonstrate the possibilities of improved surveillance practices. Method: Data from three national sources were collected and matched; a special database on fatal fires held by The Swedish Contingencies Agency (nationally responsible for fire prevention), a database on forensic medical examinations held by the National Board of Forensic Medicine, and the cause of death register held by the Swedish National Board of Health and Welfare. Results: The results disclose considerable underreporting in the single sources. The national database on fatal fires, serving as the principal source for policymaking on fireprevention matters, underestimates the true situation by 20 %. Its coverage of residential fires appears to be better than other fires. Conclusions: Systematic safety work and informed policy-making presuppose access to correct and reliable numbers. By combining several different sources, as suggested in this study, the national database on fatal fires is now considerably improved and includes regular matching with complementary sources.

This study examines temporal trends in deaths due to fire-related accidents in Sweden from 1952 to 2013 based on statistics in the Cause of Death register held by the Swedish National Board of Health and Welfare. Fatalities coded with underlying cause of death associated with fire-related accidents are included and absolute numbers and age-adjusted mortality rates are calculated and statistically analysed for trends using Poisson regression. The results show a significant reduction in both absolute numbers and in the age-adjusted mortality rate with a decline in absolute number of deaths of 34% over the period. However, the elderly population (80+ years) showed a significant increase in absolute numbers. Regarding the age-adjusted mortality rate, a significant reduction of 63% was observed and children aged 0 to 4 years showed the largest decrease (91%). A reduction was seen both in terms of fatalities due to burns and carbon monoxide poisoning, although the reduction was more pronounced with regards to burns (69% compared to 46%). Although an overall decrease was observed in both absolute numbers and in the age-adjusted mortality rate, with an aging population, the absolute numbers of fire-related deaths for the elderly population will most likely increase in the future. Therefore, whilst previously a child-injury issue, fire-related deaths in Sweden is now predominantly an issue of safety for the elderly. In combination with more deaths now being attributed to carbon monoxide poisoning, new preventative strategies may be required