Alcohol use among fatally injured victims in São Paulo, Brazil: bridging the gap between research and health services in developing countries

Abstract

Background and aims Most studies reporting alcohol use among fatally injured victims are subject to bias, particularly that related to sample selection and to absence of injury context data. We developed a research method to estimate the prevalence of alcohol consumption and test correlates of alcohol use prior to fatal injuries, using the city of Sao Paulo, Brazil as a model. Design, Setting and Participants Cross-sectional study based on a probability sample of fatally injured adult victims (N=365) autopsied in Sao Paulo, Brazil. Victims were sampled within systematically selected 8-hour sampling blocks, generating a representative sample of fatal injuries occurring during all hours of the day for each day of the week between June 2014 and December 2015. Measurements The presence of alcohol and blood alcohol concentration (BAC) were the primary outcomes evaluated according to victims’ socio-demographic, injury context data (type, day, time and injury place), and criminal history characteristics. Findings Alcohol was detected in 30.1% (CI 95%; 25.6–35.1) of the victims, with a mean BAC level of 0.11% w/v (CI 95%; 0.09–0.13) among alcohol-positive cases. Those black and mixed race presented a higher mean BAC than white victims (p=0.03). Less than one in every six suicides tested positive for alcohol, while almost half of traffic-related casualties were alcohol-positive. Having suffered traffic-related injuries, particularly those involving vehicle crashes, and injuries occurring during weekends and at night were significantly associated with alcohol use before injury (p<0.05). Conclusions Nearly one third of fatal injuries in Sao Paulo were alcohol-related, with traffic accidents showing a greater association with alcohol use than other injuries. The sampling methodology tested here, including the possibility of adding injury context data to improve population-based estimates of alcohol use before fatal injury, was found to be a reliable and lower cost strategy for avoiding biases common in death investigations.

Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil

“…Males and younger ages (15-29 years) were the most common groups. These findings are consistent with national (Brazilian) and international literature that identified gender and age as significant predictors of alcohol-related injuries, with a greater prevalence of alcohol-related injuries occurring among young men (5,11,(25)(26)(27)(28)(29)(30)(31)33). Similarly, the most recent Pan American Health Organization report on Alcohol and Health in the Americas highlights that men under the age of 30 represent the largest proportion of patients entering emergency departments with injuries (3,34).…”

“…To date, many studies have corroborated a high burden of alcohol-related injury in Brazil and the presence of SES disparities among the injured (3,5,11,(25)(26)(27)(28)(29)(30)(31)(32). To our knowledge, this study is the first to describe socioeconomic and demographic characteristics of non-fatal alcohol-related injuries, specifically in LMICs, and one of the few looking at non-fatal injuries outside of a large metropolitan area of Brazil.…”

“…To date, much of the patient-level data on alcohol-related injuries originate from emergency department studies focused on fatally injured patients and from large metropolitan areas, thus are not representative of all regions across Brazil (3,11). Brazil, as a proxy to many LAC countries, has a heterogeneous socioeconomic distribution by and across regions; more data describing communities outside state capitals or large metropolitan areas is crucial to understand the unique characteristics of alcohol-related injuries.…”

Estimating alcohol‐attributable fractions for injuries based on data from emergency department and observational studies: a comparison of two methods

“…Furthermore, for the United States, the population‐based AAFs were approximately 39–41%, suggesting that these AAFs may be biased upwards. A recent study of a representative sample of injury fatalities in São Paulo found a 30% prevalence of alcohol presence (BAC ≥ 0.01 g/dl), higher than our ED estimate (9%) but lower than the population estimate (41%). More research is needed for comparison with studies such as medical examiners’ reports or registry data, including updating the systematic review by Smith et al .…”

The Effect of Pre-Trauma Alcohol Use on Post-Traumatic Quality of Life in Severely Injured Trauma Patients

“…Frequent alcohol use is a known risk factor for various injuries (13)(14)(15) and also decreases overall quality of life (16,17). From one third up to half of all injured patients admitted to emergency rooms have been shown to have a positive blood alcohol level (BAL) upon admission (13,(18)(19)(20).…”