A Systematic Review and Meta‐Analysis of Alcohol Consumption and Injury Risk as a Function of Study Design and Recall Period

Abstract

Background It is well established that alcohol consumption is associated with an increased risk of injury. This systematic review and meta-analysis addresses important methodological issues commonly encountered in the alcohol and injury field by delineating the effect of study design and alcohol consumption recall period on effects size magnitude and by conducting gender-specific analyses. Methods Meta-analyses using random effect models. Data sources were peer-reviewed studies on alcohol and injury from 1970 to 2009 from MEDLINE, Psych Info and on-line journals. Case-control or case crossover ED studies reporting injury risk and alcohol consumed six hours before injury were included. Results The overall odds of injury were 2.799 (2.214–3.538, p<0.001). For case-crossover studies, the odds were 3.815 (2.646–5.499, p<0.001), for ED case-control studies the odds were 1.977 (1.385–2.821, p<0.001) and for population case-control designs the odds were 3.145 (1.583–6.247, p<0.005). The ‘usual frequency’ recall period yielded an odds ratio of 4.235 (2.541–7.057, p<0.001), compared to 2.320 (1.789–3.008, p<0.001) for all other methods. There were significant differences in odds ratio magnitude when comparing studies by design and recall period. Females had higher odds of injury than males, 2.285 (1.361–3.836, p<0.005) vs. 1.071 (0.715–1.605, p=0.737). Conclusions Study design and alcohol consumption recall period have significant effects on effect size magnitude in estimating risk of injury from alcohol consumption six hours prior to injury. For the ‘usual frequency’ case-crossover design, significant moderator effects were found, resulting in over-estimates of injury risk from alcohol. ED case-crossover designs tend to overestimate risk and ED case-control designs tend to under-estimate. We provide recommendations for future ED research.

Weekly and daily cycle of alcohol use among the U.S. general population

“…legal limit for driving) [1][2][3]. Many emergency department studies and several meta-analyses have also concluded that exposure to alcohol substantially increases the risk of injury -particularly injuries occurring within 6 h of exposure to alcohol [4][5][6][7]. Based on agreement between BAC measurement and self-reported alcohol consumption, studies such as the WHO Collaborative Study Group on Alcohol and Injuries have defined alcohol-related injury as an injury with a positive self-report of alcohol consumption in the 6 h prior to the event [4].…”

Relative risk of injury from acute alcohol consumption: modeling the dose–response relationship in emergency department data from 18 countries

“…A systematic review of emergency department (ED) studies and meta-analysis of risk of injury from drinking prior to the event (4) found an overall odds ratio (OR) of 2.79, which varied according to study design (case-control OR = 3.81; case-crossover OR = 1.98) and recall period for case-crossover studies (usual frequency OR = 4.23; time-matched OR = 2.32). Studies reviewed did not examine injury risk by level of consumption, however.…”

Principales daños sanitarios y sociales relacionados con el consumo de alcohol

“…En un metaanálisis de estudios publicados entre 1975 y 1995 se encontró una CAS≥1 g/l en el 31,5% de las muertes por homicidio, en el 22,7% de los suicidios y en el 31,0% de las producidas en accidentes no de tráfico 113 . Hay muchas evidencias de que el consumo de alcohol se asocia con un mayor riesgo de lesiones accidentales e intencionadas 63,[114][115][116][117] , la mayor parte de ellas procedentes de estudios transversales, casos y controles o casos cruzados (case crossover) realizados sobre lesionados fallecidos o atendidos en servicios de urgencias [116][117][118][119][120] . Los estudios de urgencias sugieren que el uso de alcohol aumenta el riesgo de lesiones en las seis horas siguientes 2,1-2,4 veces cuando se usan diseños de casos y controles y 5,2-6,8 veces cuando se usan diseños de casos cruzados, que el riesgo es mayor para lesiones intencionadas que accidentales y para accidentes de tráfico que para los que no son de tráfico y que existe una relación dosis-respuesta, con un aumen-to del riesgo al aumentar la CAS 116,[120][121][122] .…”