Assessing the validity of potential alcohol-related non-fatal injury indicators.
OBJECTIVE
To assess critically the face validity of the World Health Organization's (WHO's) International Guide for Monitoring Alcohol Consumption and Related Harm (MACRH) for deriving indicators, for the purposes of developing non-fatal alcohol-related injury indicators in New Zealand.


METHODS
MACRH's five solutions for deriving indicators are: (i) use only alcohol-specific cases; (ii) identify subsets of events known to be highly alcohol-related; (iii) utilize control indicators that are rarely alcohol-related; (iv) estimate alcohol attributable fractions (AAFs) and adjust indicators accordingly; and (v) develop composite indicators. These were assessed in terms of their face validity with particular reference to New Zealand.


RESULTS
There are significant face validity issues with each of the five options. Solution 4 offers the greatest promise, provided that: (i) valid AAFs can be derived and they are updated regularly; and (ii) appropriate adjustment is made for extraneous influences on the estimates of alcohol-related harm. To date, the latter has not been carried out.


CONCLUSIONS
Most potential sources of data on alcohol-related harm are subject to extraneous influences, which vary over time and space. While the attempt by WHO to offer solutions to this problem is laudable, the solutions do not address the problem adequately. MACRH guidelines need to be revised to include criteria for a valid outcome indicator.
Langley
John
J
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. john.langley@ipru.otago.ac.nz
Kypri
Kypros
K
Cryer
Colin
C
Davie
Gabrielle
G
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000428:Alcohol Drinking / Q000009:adverse effects*; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000209:etiology; D000431:Ethanol / Q000506:poisoning; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D009520:New Zealand / Q000453:epidemiology; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000209:etiology*
D000431:Ethanol