By ERIC NAGOURNEY

s many as 20,000 Americans died in accidents at home in 1998, a new survey reports, and an additional 7 million were hurt.

The study was released by the Injury Prevention Research Center, part of the University of North Carolina, and was based on a review of death certificates, emergency and clinic records and earlier studies.

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The researchers, led by Dr. Carol W. Runyan, also conducted a telephone survey of more than 1,000 households. Among its findings: 56 percent of the adults interviewed said they could think of nothing they should do to make their homes safer.

Leading the list of dangerous household accidents are falls, with poisonings a distance second. The study also cited fires, inhalation of dangerous fumes, suffocation and drowning. The poisonings, it said, involved not only children ingesting inappropriate materials but adults who mixed medications or illegal drugs.

The researchers found that almost all homes now have smoke alarms. But they said inadequate railings and banisters remained problems, as did improperly stored medicines and poisons.

Many people do not pay attention to the temperature settings on their water heaters, the study reported, and in the households where guns are kept, they are locked up less than half the time.