Aerosol Dusters as the Predominant Source of Inhalant Abuse Mortality: Evidence From the U.S. CPSC Clearinghouse, 2011–2021

Abstract Background Intentional inhalation of 1,1-difluoroethane (DFE), the propellant in aerosol duster products, is a leading cause of inhalant-abuse death in the United States. The CPSC has cited death counts from its Clearinghouse in regulatory proceedings, yet no peer-reviewed publication has described the methods used to identify these cases. Objectives To estimate DFE- and duster-related deaths in the CPSC Clearinghouse for 2011–2021, characterize reporting patterns, and assess classification reliability against an independently coded dataset. Methods Death records (N = 6,316) were identified from 261,076 Clearinghouse records using CPSC product codes for chemicals, aerosols, gases, and related products. Each record was classified through narrative review and substance coding. Inter-rater reliability was assessed against an independently coded dataset from Families United Against Inhalant Abuse (FUAIA) using Cohen’s kappa and Gwet’s AC1. Results Of 2,451 inhalant-abuse deaths identified (70.8% male; mean age 36.9 years), 2,097 (85.6%) involved DFE or aerosol duster products. DFE/duster deaths rose from 110 (2011) to 266 (2016). Only 17% of cases were received in the same calendar year as the incident. Prior to reconciliation, comparison with the FUAIA dataset yielded Cohen’s kappa of 0.90 (95% CI [0.89, 0.91]); all discrepancies were subsequently resolved through joint review. Conclusion Aerosol duster products account for approximately 86% of inhalant-abuse deaths reported to the CPSC Clearinghouse; however, these counts significantly underestimate true prevalence. The concentration of mortality in a single, widely available product class supports targeted product-level interventions and provides the first peer-reviewed baseline for evaluating the impact of regulatory and prevention efforts.