title: A population-based case-crossover and case-control study of alcohol and the risk of injury.
abstract: OBJECTIVE
  This study investigated the relationship between alcohol and the risk of acute injury, examining both short-term (drinking over a few hours) and long-term exposures (past-month hazardous drinking and current alcohol use disorders).
  
  
  METHODS
  The study was a case-crossover and population-based case control study. Cases (N = 2,517; 1,432 men) were injured patients recruited from all three emergency departments in Boone County, Missouri. Each case's alcohol consumption in the 6 hours prior to injury was compared to his or her consumption the day before in a case-crossover analysis. Community controls (N = 1,856; 948 men) were recruited by telephone and matched to cases by age, gender, day of week and hour. Case-control analyses examined recent alcohol consumption (past 6 hours), past-month hazardous drinking and past-year alcohol use disorders.
  
  
  RESULTS
  The odds ratios (ORs) for injury associated with short-term alcohol exposure were similar, whether cases were compared with themselves (case-crossover analyses) or with others (case-control analyses). After 1 or 2 drinks in a 6-hour interval, the ORs were 1.8 (95% confidence interval [CI]: 1.3-2.6) and 1.5 (0.96-2.2), respectively. Similar dose-response curves were seen in the two comparisons, with ORs of 6.2 and 3.7, respectively, after 3 or 4 drinks and 9.5 and 13.5 after 5 or 6 drinks. For past-month hazardous drinking, the OR was 1.7 (95% CI: 1.2-2.3). Current alcohol dependence was associated with injury (OR = 1.9; 95% CI: 1.5-2.6), but alcohol abuse was not (OR = 0.9; 95% CI: 0.8-1.1).
  
  
  CONCLUSIONS
  Alcohol's effect on injury risk is related more strongly to acute exposure than to measures of long-term exposure. The risk is significant even at low levels of consumption.
authors.affiliation: Department of Family and Community Medicine, M231 Health Sciences, University of Missouri-Columbia, Columbia, Missouri 65212, USA. VinsonD@health.missouri.edu
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Vinson
authors.forename: Malcolm
authors.initials: M
authors.lastname: Maclure
authors.forename: Carol
authors.initials: C
authors.lastname: Reidinger
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D016022:Case-Control Studies; D016001:Confidence Intervals; D018592:Cross-Over Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000523:psychology