title: Alcohol use among fatally injured victims in São Paulo, Brazil: bridging the gap between research and health services in developing countries.
abstract: Most studies reporting alcohol use among fatally injured victims are subject to bias, particularly those related to sample selection and to absence of injury context data. We developed a research method to estimate the prevalence of alcohol consumption and test correlates of alcohol use prior to fatal injuries.
  
  
  
  Cross-sectional study based on a probability sample of fatally injured adult victims (n = 365) autopsied in São Paulo, Brazil. Victims were sampled within systematically selected 8-hour sampling blocks, generating a representative sample of fatal injuries occurring during all hours of the day for each day of the week between June 2014 and December 2015.
  
  
  
  The presence of alcohol and blood alcohol concentration (BAC) were the primary outcomes evaluated according to victims' socio-demographic, injury context data (type, day, time and injury place) and criminal history characteristics.
  
  
  
  Alcohol was detected in 30.1% [95% confidence interval (CI) = 25.6-35.1)] of the victims, with a mean blood alcohol level (BAC) level of 0.11% w/v (95% CI = 0.09-0.13) among alcohol-positive cases. Black and mixed race victims presented a higher mean BAC than white victims (P = 0.03). Fewer than one in every six suicides tested positive for alcohol, while almost half of traffic-related casualties were alcohol-positive. Having suffered traffic-related injuries, particularly those involving vehicle crashes, and injuries occurring during weekends and at night were associated significantly with alcohol use before injury (P < 0.05).
  
  
  
  Nearly one-third of fatal injuries in São Paulo between June 2014 and December 2015 were alcohol-related, with traffic accidents showing a greater association with alcohol use than other injuries. The sampling methodology tested here, including the possibility of adding injury context data to improve population-based estimates of alcohol use before fatal injury, appears to be a reliable and lower-cost strategy for avoiding biases common in death investigations.
authors.affiliation: University of São Paulo Medical School, São Paulo, Brazil.|Alcohol Research Group, Emeryville, CA, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Andreuccetti
authors.affiliation: University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Vilma
authors.initials: V
authors.lastname: Leyton
authors.affiliation: Forensic Laboratory Division, Office of the Chief Medical Examiner, San Francisco, CA, USA.|Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Nikolas P
authors.initials: NP
authors.lastname: Lemos
authors.affiliation: University of São Paulo Medical School, São Paulo, Brazil.|Technical-Scientific Police Superintendency of the State of São Paulo, São Paulo, Brazil.
authors.forename: Ivan Dieb
authors.initials: ID
authors.lastname: Miziara
authors.affiliation: Alcohol Research Group, Emeryville, CA, USA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ye
authors.affiliation: University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Takitane
authors.affiliation: University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Daniel Romero
authors.initials: DR
authors.lastname: Munoz
authors.affiliation: School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
authors.affiliation: Alcohol Research Group, Emeryville, CA, USA.
authors.forename: Cheryl J
authors.initials: CJ
authors.lastname: Cherpitel
authors.affiliation: University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Heraclito Barbosa
authors.initials: HB
authors.lastname: de Carvalho
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data; D000328:Adult; D000428:Alcohol Drinking / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology; D001344:Autopsy; D044383:Black People; D000067401:Blood Alcohol Content; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006296:Health Services; D006708:Homicide / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D012106:Research; D013405:Suicide / Q000208:ethnology / Q000706:statistics & numerical data*; D013997:Time Factors; D044465:White People; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality*
chemical_list: D000067401:Blood Alcohol Content
keywords: Alcohol; BAC; Brazil; deaths; injuries; toxicology