Alcohol use among fatally injured victims in São Paulo, Brazil: bridging the gap between research and health services in developing countries

Shifting patterns of disparities in unintentional injury mortality rates in the United States, 1999-2016

OBJECTIVES

To analyze changes in racial/ethnic disparities for unintentional injury mortality from 1999-2016.

METHODS

Mortality data are from the National Center for Health Statistics (NCHS) for all unintentional injuries, analyzed separately by injury cause (motor vehicle accidents [MVA], poisonings, other unintentional) for white,black, and Hispanic populations within four age groups: 15-19, 20-34, 35-54, 55-74 for males and for females.

RESULTS

Rates across race/ethnic groups varied by gender, age and cause of injury. Unintentional injury mortality showed a recent increase for both males and females, which was more marked among males and for poisoning in all race/ethnic groups of both genders. Whites showed highest rates of poisoning mortality and the steepest increase for both genders, except for black males aged 55-74. MVA mortality also showed an increase for all race/ethnic groups, with a sharper rise among blacks, while Hispanics had lower rates than either whites or blacks. Rates for other unintentional injury mortality were similar across groups except for white women over 55, for whom rates were elevated.

CONCLUSIONS

Data suggest while mortality from unintentional injury related to MVA and poisoning is on the rise for both genders and in most age groups, blacks compared to whites and Hispanics may be suffering a disproportionate burden of mortality related to MVAs and to poisonings among those over 55, which may be related to substance use.

Gender differences in driving control of young alcohol-impaired drivers

BACKGROUND

Male and female drivers exhibit different degrees of vehicle control while driving under the influence of alcohol. However, this interaction between alcohol and gender is understudied. The present study examined the effects of different alcohol levels on the driving control of male and female drivers with the help of driving simulator experiments in heterogeneous traffic conditions.

METHOD

Forty young drivers (20 males and 20 females) completed simulated driving at four Blood Alcohol Concentration (BAC) levels: 0% (control), 0.03%, 0.05% and 0.08%. Driving impairment in vehicle control was measured in terms of average speed, acceleration variability and reaction time of drivers. Repeated-measures ANOVA tests were conducted and regression models were developed for male and female drivers to quantify the effects of BAC levels and driver characteristics on the driving control measures.

RESULTS

Significant effects of gender were observed for average speed (p <  0.001) and acceleration variability (p = 0.015) but not for reaction time of drivers (p =  0.891). Further, the effect of BAC was significant in all the three measures of vehicle control (p <  0.001). Driving control improved with increasing age of male drivers while caffeine consumption was observed as an alcohol-antagonizing factor in female drivers.

CONCLUSION

The findings suggest that vehicle control of female drivers is more likely to get affected even at low BAC levels, providing evidence that they belong to critical section of driving community in terms of alcohol-related impairment. The findings may help in discouraging drinking and driving among male and female drivers.

Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil

Background: Previous research has corroborated a high burden of alcohol-related injury in Brazil and the presence of socioeconomic disparities among the injured. Yet, individual-level data is scarce. To fill this gap, we examined the association between demographic and socioeconomic characteristics with non-fatal alcohol-related injury in Maringá, Brazil.

Methods: We used household survey data collected during a 2015 cross-sectional study. We conducted univariate and multivariate analyses to evaluate associations of demographic (age, gender, race) and socioeconomic characteristics (employment, education, income) with non-fatal alcohol-related injury.

Results: Of the 995 participants who reported injuries, 62 (6.26%) were alcohol-related. Fifty-three (85%) alcohol-related injuries were reported by males. Multivariate analysis indicated being male (OR = 5.98 95% CI = 3.02, 13.28), 15–29 years of age (OR = 3.62 95% CI = 1.72, 7.71), and identifying as Black (OR = 2.38 95% CI = 1.09, 4.95) were all significantly associated with increased likelihood of reporting an alcohol-related injury, whereas unemployment was significantly associated with decreased likelihood of reporting an alcohol-related injury (OR = 0.41 95% CI = 0.18, 0.88).

Conclusion: Our findings suggest that in Maringá, being male, between the ages of 15 and 29, employed, or identifying as Black were characteristics associated with a higher risk for non-fatal alcohol-related injury. Individual level data, such as ours, should be considered in combination with area-level and country-level data when developing evidence-based public-health policies.

Alcohol Consumption and Violent Deaths in the City of Sao Paulo in 2015

Background: Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control, making people more vulnerable to violence and accidents, with thus a potential association between alcohol consumption and violent deaths. Objective: To assess the association between alcohol consumption and violent deaths in the city of Sao Paulo, Brazil, in 2015, and its relationship with gender, age, cause of death and blood alcohol concentration (BAC) of victims. Methods: A cross-sectional retrospective study was conducted by collection of data from 2,882 victims of violent deaths subjected to examination of BAC from the archives of the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Results: Alcohol was detected in blood samples of 27.06% of the victims and mean BAC levels were 1.92 ± 1.24 g/L. The mean age of the victims was 33.49 ± 15.19 years. The majority of the victims were male (84.14%) and the prevalence of positive BAC was higher amongst men (28.74%) than women (18.16%). Homicide was the most prevalent cause of death in the sample (36.57%), but there were a higher proportion of traffic accidents victims with positive BAC (32.01%), as well as higher BAC levels in these victims (46.77% in the range of 1.6-2.5 g/L). Conclusions: The results obtained in this study support a potential association between alcohol consumption and violent deaths in the city of Sao Paulo, mainly in traffic accidents victims.

Drink driving and speeding in Sao Paulo, Brazil: empirical cross-sectional study (2015-2018)

OBJECTIVES

To evaluate the prevalence of drink driving and speeding during 2015-2018 in Sao Paulo, Brazil.

DESIGN

Cross-sectional observational study.

SETTING

Roads representing the five main regions of the city of Sao Paulo in Brazil, one of the world's largest urban areas.

PARTICIPANTS

Drivers (N=10 294) stopped at routine roadside breath testing checkpoints and those driving in selected roads for speeding measurement (N=414 664).

PRIMARY AND SECONDARY OUTCOME MEASURES

Microwave radar guns were used to measure the speed of vehicles, while the prevalence of drivers under the influence of alcohol was observed in police checkpoints. Data were collected during three consecutive years (2016-2018) following a baseline study established in 2015 using a city-level representative sample of observational data representing all days of the week.

RESULTS

Alcohol-related fatalities kept at a constantly high percentage, with 39% of road traffic deaths involving alcohol in 2016. Drivers testing above the legal breath alcohol concentration limit showed a decreasing trend, from 4.1% (95% CI 2.9% to 5.5%) at baseline to 0.6% (95% CI 0.2% to 1.2%) in the end of 2018 (p<0.001); however, more than half of drivers refused breath tests at checkpoints despite steep legal penalties. The prevalence of speeding among all vehicles decreased from 8.1% (95% CI 7.9% to 8.2%) to 4.9% (95% CI 4.7% to 5.1%) by the end of 2016 (p<0.001), but then increased again to 13.5% (95% CI 13.2% to 13.9%) at the end of the study period (p<0.001).

CONCLUSIONS

Drink driving rates have reduced, likely due to an increase in drivers refusing breath alcohol tests, while speeding rates have increased significantly by the end of the study period, particularly among motorcycles. Future strategies aiming at reducing road traffic injuries in the major Brazilian city should tailor drink driving and speeding enforcement based on the new evidence provided here.

Estimating alcohol-attributable fractions for injuries based on data from emergency department and observational studies: a comparison of two methods

AIM

To compare the injury alcohol-attributable fractions (AAFs) estimated using emergency department (ED) data to AAFs estimated by combining population alcohol consumption data with corresponding relative risks (RRs).

DESIGN

Comparative risk assessment.

SETTING AND PARTICIPANTS

ED studies in 27 countries (n = 24 971).

MEASUREMENTS

AAFs were estimated by means of an acute method using data on injury cases from 36 ED studies combined with odds ratios obtained from ED case-cross-over studies. Corresponding AAFs for injuries were estimated by combining population-level data on alcohol consumption obtained from the Global Information System on Alcohol and Health, with corresponding RRs obtained from a previous meta-analysis.

FINDINGS

ED-based injury AAF estimates ranged from 5% (Canada 2002 and the Czech Republic) to 40% (South Africa), with a mean AAF among all studies of 15.4% (18.9% for males and 8.4% for females). Population-based injury AAF estimates ranged from 21% (India) to 51% (Spain and the Czech Republic), with a mean AAF among all country-years of 36.8% (42.5% for males and 22.5% for females). The Pearson correlation coefficient for the two types of injury AAF estimates was 0.09 for the total, 0.06 for males and 0.32 for females.

CONCLUSIONS

Two methods of estimating the injury alcohol-attributable fractions-emergency department data versus population method-produce widely differing results. Across 36 country-years, the mean AAF using the population method was 36.8%, more than twice as large as emergency department data-based acute estimates, which average 15.4%.

Alcohol in combination with illicit drugs among fatal injuries in Sao Paulo, Brazil: An epidemiological study on the association between acute substance use and injury

Injury deaths have a major impact on public health systems, particularly in the Latin American region; however, little is known about how different drugs, in combination or not with alcohol, interact with each injury type. We tested an epidemiological protocol for investigating alcohol and other drug acute use among fatally injured victims taking into account the injury context for all injury causes in Sao Paulo, Brazil. Blood alcohol and drug content were fully screened and confirmed following a probability sample selection of decedents (n = 365) during 19 consecutive months (2014-2015). Drug concentrations, including benzodiazepines, cannabis, cocaine, and opioids were determined by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography tandem mass spectrometry (LC-MS/MS). Toxicology data were interpreted in combination with injury context retrieved from police records regarding cause, place of injury, and victims' criminal history. More than half of all fatally injured victims studied were under the influence of at least one substance (55.3%). Alcohol was the leading substance consumed before a fatal injury event (30.1%), followed by cocaine (21.9%) and cannabis (14%). Illicit drug use (cocaine and cannabis) comprised more than two thirds of all drug-related deaths. Alcohol-positive deaths are over-represented among road traffic injuries, while drug-positive deaths are more prevalent among intentional injuries. Victims who had previous criminal convictions were significantly more likely to have used illicit drugs compared to those who did not have a criminal background. We estimated that one in every two fatal injuries in the city of Sao Paulo is associated with acute substance use by the victim. The health burden attributed to alcohol- and drug-related fatal injury events has reached significant higher levels in Latin American cities such as Sao Paulo compared globally.