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

Abstract

Aims Update and extend analysis of the dose-response relationship of injury and drinking by demographic and injury subgroups and country-level drinking pattern, and examine the validity and efficiency of the fractional polynomial approach to modeling this relationship. Design Pair-matched case-crossover analysis of drinking prior to injury, using categorical step-function and fractional polynomial analysis. Setting 37 emergency departments (EDs) across 18 countries. Participants 13,119 injured drinkers arriving at the ED within six hours of the event Measurements The dose-response relationship was analyzed by gender, age, cause of injury (traffic, violence, fall, other), and country detrimental drinking pattern (DDP). Findings Estimated risks were similar between the two analytic methods, with injury risk doubling at one drink (OR = 2.3 – 2.7) and peaking at about 30 drinks. Although risk was similar for males and females up to three drinks (OR = 4.6), it appeared to increase more rapidly for females and was significantly higher starting from 20 drinks (female OR = 28.6; CI (16.8, 48.9); male OR = 12.8; CI (10.1, 16.3)). No significant differences were found across age groups. Risk was significantly higher for violence-related injury than for other causes across the volume range. Risk was also higher at all volumes for DDP-3 compared to DDP-2 countries Conclusions An increasing risk relationship was found between alcohol and injury, but risk was not uniform across gender, cause of injury, or country drinking pattern. The fractional polynomial approach was found to be a valid and efficient approach for modeling the alcohol-injury risk relationship.

Alcohol and Road Traffic Injuries in Latin America and the Caribbean: A Case-Crossover Study

“…Unfortunately, our sample size per study site is too small for studying variations in ORs by study site by age/sex or drinking level, but prior studies from Cherpitel et al (2015a) on possible effects of a country-level drinking pattern determined by the World Health Organization (WHO) country's detrimental drinking pattern (Rehm et al, 2001) shows that countries with the most detrimental drinking patterns may have increased alcohol attributable fractions for injuries compared to countries with a lower detrimental drinking pattern. The finding that at low and middle levels of drinking there is extensive PAR, brings attention to population measures for all drinkers and not only those with alcohol use disorders, as stated before (Poikolainen et al, 2007).…”

“…Variations in the magnitude of the OR across levels of fixed characteristics (study site, sex, age, type of road traffic injury) were examined using the X2 test of homogeneity (Rothman et al, 2008). The analysis of dose-response relationship between the amount of drinking 6 hours prior and the RTI using fractional polynomial and calculations of alcohol attributable fractions, or population attributable risk (PAR), is explained in full detail in two prior works from our group (Cherpitel et al, 2015a; 2015b). Briefly, this approach circumvents the more traditional use of preset cut-points that are somehow arbitrary (for example, 1-10 drinks; 11-20 drinks, etc.).…”

“…The World Health Organization estimated that 13% of all disability-adjusted life years (DALYS) for RTIs was attributable to alcohol (World Health Organization, 2014). It is well established that drinking alcohol increases the risk of a traffic crash (Cherpitel et al, 2015a; Krüger et al, 1995; Taylor et al, 2010). Evidence of this link is also available for some countries in the region (Pechansky et al, 2010), as well as data suggesting that alcohol-related road traffic deaths reduce the life expectancy (Andreuccetti et al, 2012; Borges et al, 2013; Chandran et al, 2013; Saldanha et al, 2014; Ye et al, 2013b) and increase years of life lost (Andreuccetti et al, 2013; Sousa et al, 2010).…”

“…Our goal is to report the risk of an RTI when drinking prior to the event and population attributable risk (PAR) for cases of RTI from 10 countries of Latin America and the Caribbean (Argentina, Brazil, Costa Rica, Dominican Republic, Guatemala, Guyana, Mexico, Nicaragua, Panama & Trinidad and Tobago) using a case-crossover design (Borges et al, 2006; Borges et al, 2013) with a new approach to estimate dose-response curves and attributable fractions (Cherpitel et al, 2015a; Cherpitel et al, 2015b) for this population. The case-crossover design is especially suited for studying the impact of a transient exposure (such as alcohol and drug use- i.e.…”

Participation in Mind-Body-Spirit Programs and Length of Stay in a Residential Addiction Treatment Facility: A Retrospective Analysis

“…Recent numbers published by SAMHSA indicate that of the 22.7 M people who need treatment for the substance use disorder, only about 2.5 M (~10%) received the treatment [1]. In addition to a public health concern, SUDs also pose a heavy economic burden to the healthcare system and to the workplace [2] [3] [4].…”