Relative risk of injury from acute alcohol consumption: modeling the dose–response relationship in emergency department data from 18 countries
- 30 October 2014
- Vol. 110 (2), 279-288
- https://doi.org/10.1111/add.12755
Abstract
Aims 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. Design Pair‐matched case–cross‐over analysis of drinking prior to injury, using categorical step‐function and fractional polynomial analysis. Setting Thirty‐seven emergency departments (EDs) across 18 countries. Participants A total of 13 119 injured drinkers arriving at the ED within 6 hours of the event. Measurements The dose–response relationship was analyzed by gender, age, cause of injury (traffic, violence, fall, other) and country detrimental drinking pattern (DDP). Findings 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.Keywords
Funding Information
- US National Institute on Alcohol Abuse and Alcoholism (NIAAA) (RO1 2 AA013750-04)
- NIAAA (AA 005595)
This publication has 31 references indexed in Scilit:
- The more you drink, the harder you fall: A systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase togetherDrug and Alcohol Dependence, 2010
- Alcohol and cannabis use as risk factors for injury – a case-crossover analysis in a Swiss hospital emergency departmentBMC Public Health, 2009
- Alcohol and injuries: a review of international emergency room studies since 1995Drug and Alcohol Review, 2007
- Multicentre study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuriesBulletin of the World Health Organization, 2006
- Injury severity: Role of alcohol, substance use and risk‐takingEmergency Medicine Australasia, 2006
- Risk of injury from acute alcohol consumption and the influence of confoundersAddiction, 2004
- Building Multivariable Prognostic and Diagnostic Models: Transformation of the Predictors by Using Fractional PolynomialsJournal of the Royal Statistical Society Series A: Statistics in Society, 1999
- Drinking Patterns and Problems and Drinking in the Event: An Analysis of Injury by Cause Among Casualty PatientsAlcohol: Clinical and Experimental Research, 1996
- Regression Using Fractional Polynomials of Continuous Covariates: Parsimonious Parametric ModellingJournal of the Royal Statistical Society Series C: Applied Statistics, 1994
- Effect of Categorizing a Continuous Covariate on the Comparison of Survival TimeJournal of the American Statistical Association, 1986