Alcohol-Related Injuries: Evidence for the Prevention Paradox

Article Figures & Data

Table 1.

Description of Participants

Characteristic	All Cases (N = 2,517)No. (%)	Cases From Covered Shifts (n = 2,161)No. (%)	Community Controls (n = 1,856)No. (%)
Sex
Women	1,085 (43.1)	967 (44.7)	908 (48.9)
Men	1,432 (56.9)	1,194 (55.3)	948 (51.1)
Age, years
18 to 20	419 (16.6)	379 (17.5)	201 (10.8)
21 to 29	716 (28.4)	636 (29.4)	560 (30.2)
30 to 44	761 (30.2)	658 (30.4)	616 (33.2)
45 to 64	421 (16.7)	325 (15.0)	329 (17.7)
65 and over	200 (7.9)	163 (7.5)	150 (8.1)
Alcohol use disorders	497 (19.7)	433 (20.0)	307 (16.5)
Alcohol abuse	293 (11.6)	255 (11.8)	232 (12.5)
Alcohol dependence	204 (8.1)	178 (8.2)	75 (4.0)
Location of residence
Rural	723 (28.7)	478 (22.1)	430 (23.2)
Urban	1,794 (71.3)	1,683 (77.9)	1,426 (76.8)
Alcohol consumed in 6 h before injury or, among controls, the matched hour
Any	352 (14.0)	266 (12.3)	97 (5.2)

Drinks in 6-h Window No.	Men (n = 1,432) No. (%)	Women (n = 1,085) No. (%)	Men (n = 1,194) No. (%)	Women (n = 967) No. (%)	Men (n = 948) No. (%)	Women (n = 908) No. (%)
All percentages are column percentages. Percentages for age-groups do not add to 100 because of rounding.
1 drink	34 (2.4)	17 (1.6)	29 (2.4)	16 (1.7)	23 (2.4)	18 (2.0)
2 drinks	38 (2.7)	14 (1.3)	23 (1.9)	12 (1.2)	14 (1.5)	6 (0.7)
3 drinks	32 (2.2)	13 (1.2)	21 (1.8)	9 (0.9)	11 (1.2)	3 (0.3)
4 drinks	32 (2.2)	8 (0.7)	25 (2.1)	6 (0.6)	8 (0.8)	0 (0)
5 or 6 drinks	52 (3.7)	26 (2.4)	40 (3.4)	21 (2.2)	5 (0.5)	1 (0.1)
7 or more drinks	68 (4.8)	18 (1.7)	49 (4.1)	15 (1.6)	7 (0.7)	1 (0.1)

Table 2.

Population Attributable Fraction (PAF) due to Alcohol Consumption During the Previous 6 Hours

Level of Drinking	Cases With This Level of Consumption No. (%; 95% CI)	*OR (95% CI)**	*Stratum-Specific PAF of Injuries% (95% CI)**	Total PAF of Injuries % (95% CI)
Note: We used sex-specific thresholds to define hazardous drinking: >4 on 1 occasion for men, >3 for women.
* Values of the odds ratio (OR) and PAF are rounded.
† Low risk does not necessarily mean no risk.
Case-crossover analyses (total cases = 2,510)				10.6 (7.8–13.5)
Low-risk^†	180 (7.2; 6.2–8.2)	2.7 (2.0–3.8)	4.5 (3.1–6.0)
High-risk	172 (6.8; 5.9–7.9)	9.5 (5.2–17)	6.1 (4.8–7.4)
Case-control analyses (total cases = 2,161)				8.6 (5.7–11.5)
Low-risk	135 (6.2; 5.3–7.4)	2.0 (1.4–2.8)	3.1 (1.5–4.7)
High-risk	131 (6.1; 5.1–7.2)	10.8 (5.6–21)	5.5 (4.2–6.8)

Table 3.

Population Attributable Fraction (PAF) due to Current Alcohol Use Disorders

Disorder	Cases With Disorder (N = 2,161) No. (%; 95% CI)	OR (95% CI)	PAF of Injuries% (95% CI)
* With an odds ratio <1.0, PAF cannot be meaningfully calculated.
Alcohol abuse	255 (11.8%; CI?)	0.9 (0.7–1.0)	—*
Alcohol dependence	178 (8.2%; 7.1–9.5%)	1.9 (1.5– 2.6)	4.0 (2.2–5.8)

The Article in Brief

Contrary to common beliefs, injuries that are due to drinking alcohol are more likely to be associated with an occasion of drinking than with a dependence on alcohol. In this study of 2,517 patients admitted to 3 emergency departments between 1998 and 2000, most alcohol-associated injuries occurred in persons who drank alcohol during the 6 hours before injury. Between 8.5 and 10.6 percent of all injuries could be attributed to consuming alcohol in the preceding few hours. According to the authors, levels of drinking alcohol that are considered safe are frequently associated with injury. Consuming 2 or 3 alcoholic drinks for women or 2 to 4 for men caused about 4 percent of all emergency department injury visits in this study, about the same proportion as is caused by alcohol dependence. An even greater proportion of major injuries (between 7.6 and 9.9 percent) was attributed to these levels of drinking. In 2001, 29.2 million injuries were treated in US emergency departments. Of those injuries as many as 1.3 million are possibly attributable to drinking what is considered a safe amount of alcohol.