title: Relative risk of injury from acute alcohol consumption: modeling the dose-response relationship in emergency department data from 18 countries.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  Pair-matched case-cross-over analysis of drinking prior to injury, using categorical step-function and fractional polynomial analysis.
  
  
  METHODS
  Thirty-seven emergency departments (EDs) across 18 countries.
  
  
  METHODS
  A total of 13 119 injured drinkers arriving at the ED within 6 hours of the event.
  
  
  METHODS
  The dose-response relationship was analyzed by gender, age, cause of injury (traffic, violence, fall, other) and country detrimental drinking pattern (DDP).
  
  
  RESULTS
  Estimated risks were similar between the two analytical methods, with injury risk doubling at one drink [odds ratio (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; confidence interval (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 with DDP-2 countries.
  
  
  CONCLUSIONS
  There is an increasing risk relationship between alcohol and injury but risk is not uniform across gender, cause of injury or country drinking pattern. The fractional polynomial approach is a valid and efficient approach for modeling the alcohol injury risk relationship.
authors.affiliation: Statistical and Data Services Department, Alcohol Research Group, Emeryville, CA, USA.
authors.forename: Cheryl J
authors.initials: CJ
authors.lastname: Cherpitel
authors.forename: Yu
authors.initials: Y
authors.lastname: Ye
authors.forename: Jason
authors.initials: J
authors.lastname: Bond
authors.forename: Guilherme
authors.initials: G
authors.lastname: Borges
authors.forename: Maristela
authors.initials: M
authors.lastname: Monteiro
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D000434:Alcoholic Beverages / Q000706:statistics & numerical data; D016022:Case-Control Studies; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D014754:Violence / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000201:enzymology* / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
keywords: Detrimental drinking pattern; dose-response; emergency department; gender; injury cause; injury risk