Acute alcohol consumption and injury: risk associations and attributable fractions for different injury mechanisms.
OBJECTIVE
Most studies on alcohol as a risk factor for injuries have been mechanism specific, and few have considered several mechanisms simultaneously or reported alcohol-attributable fractions (AAFs)-which was the aim of the current study.


METHODS
Data from 3,592 injured and 3,489 noninjured patients collected between January 2003 and June 2004 in the surgical ward of the emergency department of the Lausanne University Hospital (Switzerland) were analyzed. Four injury mechanisms derived from the International Classification of Diseases, 10th Revision, were considered: transportation-related injuries, falls, exposure to forces and other events, and interpersonal violence. Multinomial logistic regression models were calculated to estimate the risk relationships of different levels of alcohol consumption, using noninjured patients as quasi-controls. The AAFs were then calculated.


RESULTS
Risk relationships between injury and acute consumption were found across all mechanisms, commonly resulting in dose-response relationships. Marked differences between mechanisms were observed for relative risks and AAFs, which varied between 15.2% and 33.1% and between 10.1% and 35.9%, depending on the time window of consumption (either 6 hours or 24 hours before injury, respectively). Low and medium levels of alcohol consumption generally were associated with the most AAFs.


CONCLUSIONS
This study underscores the implications of even low levels of alcohol consumption on the risk of sustaining injuries through any of the mechanisms considered. Substantial AAFs are reported for each mechanism, particularly for injuries resulting from interpersonal violence. Observation of a so-called preventive paradox phenomenon is discussed, and prevention or intervention measures are described.
Kuendig
Hervé
H
Department of Public Health Sciences, Division of International Health, Karolinska Institutet, Nobels väg 9, SE-171 77 Stockholm, Sweden. hkuendig@gmail.com
Hasselberg
Marie
M
Laflamme
Lucie
L
Daeppen
Jean-Bernard
JB
Gmel
Gerhard
G
D000428:Alcohol Drinking / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000209:etiology*