Drinking behavior in relation to cause of death among US adults

Alcohol Consumption and 15 Causes of Fatal Injuries: A Systematic Review and Meta-Analysis

INTRODUCTION

The proportion of fatal nontraffic injuries that involve high levels of alcohol use or alcohol intoxication was assessed by cause of injury to generate alcohol-attributable fractions. Updated alcohol-attributable fractions can contribute to improved estimates of the public health impact of excessive alcohol use.

METHODS

Peer-reviewed and gray literature for 1995-2019 on 15 causes of fatal nontraffic injuries in the U.S., Canada, or Mexico were systematically reviewed, and state data systems were queried for available estimates of fatalities with recorded blood alcohol concentration levels and proportions of decedents with blood alcohol concentrations ≥0.10 g/dL by cause of injury. For each injury cause, alcohol-attributable fractions across studies were synthesized by meta-analysis of single proportions using generalized linear mixed models.

RESULTS

In total, 60 published studies and 40 additional population-level data points from 6 state data systems were included. The meta-analyzed alcohol-attributable fractions by cause of injury are as follows: air-space transport (0.03), aspiration (0.24), child maltreatment (0.09), drowning (0.31), fall injuries (0.37), fire injuries (0.34), firearm injuries (0.24), homicide (0.29), hypothermia (0.29), motor vehicle nontraffic crashes (0.42), occupational and machine injuries (0.08), other road vehicle crashes (railroad trespasser injuries) (0.63), poisoning (not alcohol) (0.20), suicide (0.21), and water transport (0.27), yielding an overall median alcohol-attributable fraction of 0.27.

DISCUSSION

Excessive alcohol use is associated with substantial proportions of violent and nonviolent injury deaths. These findings can improve the data used for estimating alcohol-attributable injury deaths and inform the planning and implementation of evidence-based strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) to prevent them.

Patterns of Drinking and Mortality from Different Diseases—An Overview

Alcohol has been linked to a considerable burden of disease worldwide. Recent epidemiological research has shown that dimensions of alcohol exposure other than average volume are causal in the etiology of disease. Based on a systematic, computer-assisted search, this article attempts a qualitative review of this literature. Results show that cardiovascular disease, especially ischaemic heart disease, is linked to patterns of drinking: regular and light to moderate drinking, and drinking with meals are cardioprotective; heavy drinking occasions have been associated with detrimental outcomes and increases in disease risk. For cancers, consumption of spirits is linked to higher risk of cancers of the upper digestive tract. Spirits also may play a particular role in causing liver cirrhosis in addition to heavy drinking occasions. Finally, injuries are especially related to high blood alcohol concentration and to the frequency of heavy drinking occasions. Overall, these findings strongly indicate that alcohol epidemiology should include adequate pattern measures into future research.

Liver biochemistry and associations with alcohol intake, hepatitis B virus infection and Inuit ethnicity: a population-based comparative epidemiological survey in Greenland and Denmark

Background

Hepatitis B virus (HBV) infection is common in Arctic populations and high alcohol intake has been associated with an increased risk of a number of diseases. Yet, a description of the influence of alcohol intake in persons with HBV infection on liver biochemistry is lacking.

Objective

We aimed to describe the association between reported alcohol intake and liver biochemistry taking into account also HBV infection, ethnicity, Inuit diet, body mass index (BMI), gender and age in an Arctic population.

Design and methods

Population-based investigation of Inuit (n=441) and non-Inuit (94) in Greenland and Inuit living in Denmark (n=136). Participants filled in a questionnaire on alcohol intake and other life style factors. Blood samples were tested for aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), bilirubin, albumin, hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. We also performed physical examinations.

Results

Participation rate was 95% in Greenland and 52% in Denmark. An alcohol intake above the recommended level was reported by 12.9% of non-Inuit in Greenland, 9.1% of Inuit in East Greenland, 6.1% of Inuit migrants and 3.4% of Inuit in the capital of Greenland (p=0.035). Alcohol intake was associated with AST (p<0.001) and GGT (p=0.001), and HBV infection was associated with ALP (p=0.001) but not with AST, GGT, bilirubin or albumin in the adjusted analysis. Inuit had higher AST (p<0.001), GGT (p<0.001) and ALP (p=0.001) values than non-Inuit after adjustment for alcohol, diet, BMI and HBV exposure. Ethnic origin modified the association between alcohol and AST, while HBV infection did not modify the associations between alcohol and liver biochemistry.

Conclusions

Non-Inuit in Greenland reported a higher alcohol intake than Inuit. Ethnic origin was more markedly associated with liver biochemistry than was alcohol intake, and Greenlandic ethnicity modified the effect of alcohol intake on AST. HBV infection was slightly associated with ALP but not with other liver biochemistry parameters.

Mortality in mothers after perinatal loss: a population-based follow-up study

OBJECTIVE

To assess whether mothers who lost a child from stillbirth or in the first week of life have an increased overall mortality and cause-specific mortality.

DESIGN

A population based follow-up study.

SETTING

Data from Danish national registers.

POPULATION

All mothers in Denmark were included in the cohort at time of their first delivery from 1 January 1980 to 31 December 2008 and followed until 31 December 2009 or death, whichever came first.

METHODS

The association between perinatal loss and total and cause-specific mortality in mothers was estimated with hazard ratios (HR) and 95% confidence intervals (95% CI) calculated using Cox proportional hazards regression analyses.

MAIN OUTCOME MEASURES

Overall mortality and cause-specific mortality.

RESULTS

During the follow-up period, 838,331 mothers in the cohort gave birth to one or more children and 7690 mothers (0.92%) experienced a perinatal loss. During follow-up, 8883 mothers (1.06%) died. There was an increased overall mortality for mothers who experienced a perinatal loss adjusted for maternal age and educational level, hazard ratio (HR) 1.83 [95% confidence interval (CI) 1.55-2.17]. The strongest association was seen in mortality from cardiovascular diseases (CVD) with an HR of 2.29 (95% CI 1.48-3.52) adjusted for CVD at time of delivery. We found no association between a perinatal loss and mortality from traumatic causes.

CONCLUSIONS

Mothers who experience a perinatal loss have an increased mortality, especially from CVD.

The effect of computer usage in internet café on cigarette smoking and alcohol use among chinese adolescents and youth: a longitudinal study

We used longitudinal data to investigate the relationship between computer use in internet cafés and smoking/drinking behavior among Chinese adolescents and young adults. Data are from two waves of the China Health and Nutrition Survey (2004 and 2006). Fixed effects models were used to examine if changes in internet café use were associated with changes in cigarette smoking and drinking of alcohol. Male café users spent on average 17.3 hours in front of the computer/week. This was associated with an increase in the probability of being a current smoker by 13.3% and with smoking 1.7 more cigarettes. Female café users spent on average 11 hours on the computer/week. This was associated with an increase in the probability of drinking wine and/or liquor by 14.74% and was not associated with smoking. Internet cafés are an important venue by which adolescent and young adults in China are exposed to smoking and drinking. Multi-component interventions are needed ranging from policies regulating cigarette and alcohol availability in these venues to anti-tobacco campaigns aimed at the general population but also at individuals who frequent these establishments.

The social consequences of binge drinking among 24- to 32-year-olds in six European countries

Data were available from general population surveys carried out in six countries in the years 2000 to 2005 under the auspices of Gender, Alcohol and Culture: An International Study (GENACIS). A total of 2089 adults aged 24-32 in the Czech Republic, Denmark, the Isle of Man, Spain, Sweden, and the United Kingdom (UK) responded to questions about their drinking habits and social consequences directly resulting from their drinking. Survey methods varied from quota sampling with face-to-face interviewing in Spain and the UK to telephone surveys in Denmark and Sweden. Response rates varied from 50% to 72%. "Binge drinking" defined as a usual amount of more than 8 UK "units" for men and more than 6 units for women was more likely than moderate drinking to lead to social consequences, fights, or being asked to cut down on drinking. There were highly significant differences between the countries both in the percentages of "heavy" drinkers and in the adverse consequences of binge drinking. In Spain, the UK, and the Czech Republic binge drinking was more likely to lead to adverse consequences than was binge drinking in the other three countries. Male gender, low educational level, high drinking frequency, and single marital status were also significantly associated with adverse social consequences from drinking, but none of these variables explained the country differences. The presence of children had little effect.

The contribution of alcohol to falls at home among working-aged adults

The role of alcohol in the occurrence and burden of fall related injury at home is unclear. We examined the contribution of alcohol to fatal and hospitalized injuries due to unintentional falls at home among working-aged adults. We conducted a population-based case-control study in Auckland, New Zealand between July 2005 and July 2006. Cases were 335 people aged 25-60 years who were admitted to hospital or died as a result of unintentional falls at home. Control subjects were 352 people randomly selected from the electoral roll from the same age band as the cases. The participants or next-of-kin completed a structured interview that ascertained data on sociodemographic, personal, and lifestyle factors including alcohol consumption. After controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding 6h relative to none was associated with a significantly increased risk of fall related injury (for two standard drinks: odds ratio: 3.7, 95% confidence interval: 1.2-10.9; for three or more drinks: odds ratio: 12.9, 95% confidence interval: 5.2-31.9). Approximately 20% of unintentional falls at home in this population may be attributable to the consumption of two or more alcoholic drinks in the preceding 6h. Drinking is strongly associated with unintentional falls at home that result in admission to hospital or death. Moreover, a substantial proportion of falls at home among working-age people can be attributed to alcohol consumption. This largely unrecognized problem should be addressed in falls prevention programs.

Health behaviors among American Indian/Alaska Native women, 1998-2000 BRFSS

BACKGROUND AND OBJECTIVE

Minority populations, including American Indians and Alaska Natives (AI/AN), in the United States generally experience a disproportionate share of adverse health outcomes compared with whites. The prevalence of risk behaviors associated with these adverse health outcomes among AI/AN women is not well documented, especially for those who live outside areas serviced by Indian Health Service. We sought to describe the prevalence of selected health risk behaviors among AI/AN women, document the disparities between AI/AN women and all U.S. women, and demonstrate the efforts needed for AI/AN women to reach Healthy People 2010 goals.

METHODS

Age-adjusted prevalence estimates for selected sociodemographic characteristics, current smoking, obesity, lack of leisure time physical activity, and binge drinking were calculated using Behavioral Risk Factor Surveillance System (BRFSS) data from 1998 to 2000, combined. Comparisons were made between prevalence estimates for AI/AN women and all women who participated in the BRFSS and Healthy People 2010 goals.

RESULTS

The prevalences of current smoking (27.8%) and obesity (26.8%) were significantly higher among AI/AN women than among all U.S. women. AI/AN women did not meet Healthy People 2010 goals for current smoking, obesity, leisure time physical activity, or binge drinking.

CONCLUSIONS

These data highlight both disparities in health risk behaviors between AI/AN women and all U.S. women and improvements needed for AI/AN women to meet Healthy People 2010 goals. This project demonstrates the overwhelming need for culturally appropriate and accessible prevention programs to address health risk behaviors associated with the leading causes of death among urbanized AI/AN women.

Alcohol consumption, risk of injury, and high-cost medical care

This study examined the effect of alcohol use on the probabilities of injury, inpatient hospital stay, and emergency department visit. Data were obtained from a sample of adults (N = 1219) recruited from a Northern California county. Alcohol use measures included number of drinks, heavy drinking days, and an indicator variable for problem drinking. Models were estimated for men and women separately while controlling for confounders. Results indicate that most alcohol use measures were not significantly related to injury probability or medical care utilization. Among the exceptions, problem drinking was a significant positive predictor of any emergency department visit for both sexes. When drinkers during the past year were divided into light, moderate, and heavy drinking groups and compared to lifetime abstainers, all male drinkers had a higher probability of injury, and light and moderate female drinkers had a lower probability of an emergency department visit.

Alcohol Consumption and Mortality among Middle-aged and Elderly Japanese Men and Women

PURPOSE

We conducted a prospective cohort study to examine the association between alcohol intake and the risk of all-cause mortality among middle-aged and elderly Japanese men and women.

METHODS

At baseline (1988-1990), a total of 110,792 Japanese men and women aged 40 to 79 years were asked to complete a questionnaire that included information on alcohol intake, and were followed up for all-cause mortality through December 31, 1999. Relative risks (95% confidence interval) were calculated using Cox proportional-hazards models.

RESULTS

The risk of all-cause mortality was lowest among current drinkers with an alcohol intake of 0.1 to 22.9 g/d (RR, 0.80; 95% CI, 0.72-0.88 for men; and RR, 0.88; 95% CI, 0.77-1.00 for women). Excessive mortality associated with heavy drinking (> or = 69 g/d) was observed for cancer, cardiovascular disease and injuries and other external causes in men, while significantly reduced mortality with light drinking was seen for cancer in men and CVD in women. For men, the benefit associated with light alcohol consumption (< 23 g/d) was more apparent among nonsmokers than among smokers.

CONCLUSION

Our prospective data show a 12% to 20% decreased risk of all-cause mortality in both Japanese men and women who consumed less than 23 g/d of alcohol (approximately 2 drinks), although heavy drinking increased that risk.

Epidemiology of severe trauma among status Aboriginal Canadians: a population-based study

BACKGROUND

Aboriginal Canadians are considered to be at increased risk of major trauma. However, population-based studies characterizing the distribution, determinants and outcomes of major trauma in this group are lacking. We sought to measure the impact of ethnicity, as reflected by Aboriginal status, on the incidence of severe trauma and to broadly define the epidemiologic characteristics of severe trauma among status Aboriginal Canadians in a large health region.

METHODS

This population-based, observational study involves all adults (people > or = 16 years) resident in the Calgary Health Region between Apr. 1, 1999, and Mar. 31, 2002. Stratification of the population into status Aboriginal Canadians and the reference population was performed by Alberta Health and Wellness using an alternate premium arrangement field within the personal health care number. Injury incidence was determined by identifying all injuries with severity scores of 12 or greater in the Alberta Trauma Registry, regional corporate data and the Office of the Medical Examiner.

RESULTS

Aboriginal Canadians were at much higher risk than the reference population in the Calgary Health Region of sustaining severe trauma (257.2 v. 68.8 per 100,000; relative risk [RR] 3.7, 95% confidence interval [CI] 3.0-4.6). Aboriginal Canadians were found to be at significantly increased risk of injuries resulting from motor vehicle crashes (RR 4.8, 95% CI 3.5-6.5), assault (RR 11.1, 95% CI 6.2-18.6) and traumatic suicide (RR 3.1, 95% CI 1.4-6.1). A trend toward higher median injury severity scores was observed among Aboriginal Canadians (21 v. 18, p = 0.09). Although the case-fatality rate among Aboriginal Canadians was less than half that in the reference population (14/93 [15%] v. 531/1686 [31%], p < 0.0001), population mortality was almost 2 times greater (RR = 1.8, 95% CI 1.0-3.0, p = 0.046).

INTERPRETATION

Severe trauma disproportionately affects Aboriginal Canadians.

Role of the gastrointestinal tract in burn sepsis

During the last 50 years, our understanding of the role of the gastrointestinal tract as a first-line defense against the development of postburn sepsis has increased dramatically. Starting with the concept of that gut-derived bacteria cause distant injury, investigators have delineated a complex series of physical changes in the barrier of the gastrointestinal tract. Along with an understanding of these physical changes has come an appreciation of the role of the immune system in modulating postburn organ failure. Importantly, recent investigations into the role of mesenteric lymph have fundamentally changed the paradigm of organ failure and have implicated the gut as a cytokine-secreting organ. This article traces the development of key concepts in the study of burn sepsis and their clinical implications.

Drinking history and risk of fatal injury: comparison among specific injury causes

The effect of acute alcohol use on injury risk is well documented, but the relationship between drinking history and fatal injury has not been adequately studied. The authors performed a case-control analysis to explore the association between drinking history and specific causes of fatal injury. Cases (n=5549) were persons who died from injury, selected from the 1993 National Mortality Followback Survey (NMFS); controls (n=42,698) were a representative sample of the general population, selected from the 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES). Current drinkers comprised 59% of the cases compared with 44% of the controls. After adjustment for age, sex, race/ethnicity, education, marital status, employment, and drug use, the odds ratio (OR) of dying from drowning for current drinkers was 3.48 (95% confidence interval (CI)=1.94, 6.25), the highest among all causes of injury studied. The lowest adjusted odds ratio associated with current drinking was for falls (OR=1.38; 95% CI=1.05, 1.82). Being a current drinker increased the risk of dying from suicide more for females (OR=4.04; 95% CI=1.64, 9.93) than for males (OR=1.45; 95% CI=1.20, 1.74). The authors conclude that drinking history is associated with a significantly increased risk of all types of fatal injury.

Eating, drinking and being depressed: the social, cultural and psychological context of alcohol consumption and nutrition in a Brazilian community

Much has been written about the socioeconomic distribution of nutritional status, both in more economically developed, and in developing nations. In general, persons of lower socioeconomic status suffer adverse consequences of poor nutritional status, although these consequences can vary depending on the level of development, i.e. in more developed countries the problem tends to be one of over-nutrition and obesity, while in developing countries the problem tends to be one of under-nutrition and nutritional deficiencies. In this paper, we explore the socioeconomic distribution of dietary intake in a Brazilian city, in an area that in some ways is neither prototypically developed or underdeveloped. The analysis presented here was stimulated by the surprising observation of no socioeconomic differences in total caloric intake in the context of extreme differences in income distribution. Further examination showed that socioeconomic differences in total caloric intake appeared after controlling for alcohol intake. A complete analysis of the data suggests that lower income leads to lower cultural consonance, which in turn leads to higher depression, higher alcohol intake, and higher total caloric intake. In this model, alcohol ingestion can be seen as both a psychological and nutritional adaptive strategy to economic, social and cultural marginality in a highly stratified society.

The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

AIMS

As part of a larger study to estimate the global burden of disease attributable to alcohol: to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and to combine exposure and risk estimates to determine regional and global alcohol-attributable fractions (AAFs) for major disease and injury categories. DESIGN, METHODS, SETTING: Systematic literature reviews were used to select diseases related to alcohol consumption. Meta-analyses of the relationship between alcohol consumption and disease and multi-level analyses of aggregate data to fill alcohol-disease relationships not currently covered by individual-level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi-level analyses with prevalence data.

FINDINGS

Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed.

CONCLUSIONS

Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.

Mortality in parents after death of a child in Denmark: a nationwide follow-up study

BACKGROUND

Little is known about the effect of parental bereavement on physical health. We investigated whether the death of a child increased mortality in parents.

METHODS

We undertook a follow-up study based on national registers. From 1980 to 1996, we enrolled 21062 parents in Denmark who had a child who had died (exposed cohort), and 293745 controls--ie, parents whose children were alive, and whose family structure matched that of the exposed cohort. Natural deaths were defined with ICD8 codes 0000-7969 and ICD10 codes A00-R99, and unnatural deaths with codes 8000-9999 and V01-Y98. We used Cox's proportional-hazards regression models to assess the mortality rate of parents up to 18 years after bereavement.

FINDINGS

We observed an increased overall mortality rate in mothers whose child had died (hazards ratio 1.43, 95% CI 1.24-1.64; p<0.0001). An excess mortality from natural causes (1.44, 1.15-1.78; p<0.0001) was noted in mothers only during the 10th-18th year of follow-up. Mothers had increased mortality rates from unnatural causes throughout follow-up, with the highest rate recorded during the first 3 years (3.84, 2.48-5.88; p<0.0001). Bereaved fathers had only an early excess mortality from unnatural causes (1.57, 1.06-2.32; p=0.04). Mothers who lost a child due to an unnatural death or an unexpected death had a hazard ratio of 1.72 (1.38-2.15; p=0.0040) and 1.67 (1.37-2.03; p=0.0037), respectively.

INTERPRETATION

The death of a child is associated with an overall increased mortality from both natural and unnatural causes in mothers, and an early increased mortality from unnatural causes in fathers.

Alcohol-related morbidity and mortality

Alcohol use is related to a wide variety of negative health outcomes including morbidity, mortality, and disability. Research on alcohol-related morbidity and mortality takes into account the varying effects of overall alcohol consumption and drinking patterns. The results from this epidemiological research indicate that alcohol use increases the risk for many chronic health consequences (e.g., diseases) and acute consequences (e.g., traffic crashes), but a certain pattern of regular light-to-moderate drinking may have beneficial effects on coronary heart disease. Several issues are relevant to the methodology of studies of alcohol-related morbidity and mortality, including the measurement of both alcohol consumption and the outcomes studied as well as study design. Broad summary measures that reflect alcohol's possible effects on morbidity, mortality, and disability may be more useful than measures of any one outcome alone.

Physician advice about smoking and drinking: are U.S. adults being informed?

BACKGROUND

Population-based estimates for the prevalence of smokers receiving advice from a health professional to quit smoking and the prevalence of binge drinkers being talked to about alcohol use are lacking for U.S. adults. This information is useful for clinicians and public health professionals.

METHODS

Data are from the Behavioral Risk Factor Surveillance System, a continuous random-digit-dial telephone survey of U.S. adults. In 1997, 10 states collected data on these health interventions for tobacco and alcohol use. The prevalence of professional advice to quit smoking and about alcohol use was calculated and examined by demographic characteristics. The number of at-risk adults who had a routine checkup in the last year and had not received these interventions was also estimated.

RESULTS

By self-report, 70% of smokers were advised to quit, and 23% of binge drinkers were talked to about their alcohol use. Using multivariate logistic regression analyses, we found among smokers that women and older persons were more likely to receive advice; among binge drinkers, health intervention was more likely to occur for men and non-Hispanic blacks. Across the 10 states, approximately 2 million smokers and 2 million binge drinkers with a routine checkup in the past 12 months were not advised to quit smoking or talked to about their alcohol use.

CONCLUSIONS

Many opportunities to intervene with smokers and binge drinkers are lost. Efforts to increase physician education and to identify and reduce other barriers may help.

Drinking histories of fatally injured drivers

CONTEXT

About 30% of drivers killed in crashes have high blood alcohol concentrations (BACs) of 0.10+ g/dl. There is a question about whether these drivers primarily are problem drinkers who chronically drink and drive-the so-called hard core drinking drivers.

OBJECTIVE

To investigate drinking histories of fatally injured drivers in relation to their BACs.

DESIGN AND PARTICIPANTS

Retrospective cohort study of 818 fatally injured drivers who were included in the 1993 National Mortality Followback Survey (a national sample of US deaths in which next of kin were interviewed) and whose BACs were recorded by the Fatality Analysis Reporting System, a census of US traffic deaths.

MAIN OUTCOME MEASURE

Problem drinking indicators.

RESULTS

At least one indicator of potential problem drinking, primarily heavy drinking, was reported for 68% of drivers with very high BACs (0.15+ g/dl), 41% with BACs of 0.10-0.14 g/dl, 32% with BACs of 0.01-0.09 g/dl, and 7% with zero BACs. Spouses provided more credible responses than other relatives: they were more likely to report at least occasional drinking and driving among deceased drivers with high BACs. For the most direct signs of problem drinking (described as a problem drinker during the last month of life or frequently driving after having five or more drinks), spousal reports suggested the prevalence of problem drinking among drivers with very high BACs was 22% (having both indicators), 32% (frequently driving after having five or more drinks), 44% (described as problem drinker), or 57% (having either indicator).

CONCLUSIONS

Drivers with BACs of 0.10+ g/dl were far more likely than sober drivers to be described as having markers of problem drinking. However, many did not have indicators suggestive of problem drinking. In addition to programs focused on repeat offenders or problem drinkers, countermeasures such as sobriety checkpoints that target a broader spectrum of drinking drivers are appropriate.

Gut-associated lymphoid T cell suppression enhances bacterial translocation in alcohol and burn injury

The mechanism of alcohol-mediated increased infection in burn patients remains unknown. With the use of a rat model of acute alcohol and burn injury, the present study ascertained whether acute alcohol exposure before thermal injury enhances gut bacterial translocation. On day 2 postinjury, we found a severalfold increase in gut bacterial translocation in rats receiving both alcohol and burn injury compared with the animals receiving either injury alone. Whereas there were no demonstrable changes in intestinal morphology in any group of animals, a significant increase in intestinal permeability was observed in ethanol- and burn-injured rats compared with the rats receiving either injury alone. We further examined the role of intestinal immune defense by determining the gut-associated lymphoid (Peyer's patches and mesenteric lymph nodes) T cell effector responses 2 days after alcohol and burn injury. Although there was a decrease in the proliferation and interferon-gamma by gut lymphoid T cells after burn injury alone; the suppression was maximum in the group of rats receiving both alcohol and burn injuries. Furthermore, the depletion of CD3(+) cells in healthy rats resulted in bacterial accumulation in mesenteric lymph nodes; such CD3(+) cell depletion in alcohol- and burn-injured rats furthered the spread of bacteria to spleen and circulation. In conclusion, our data suggest that the increased intestinal permeability and a suppression of intestinal immune defense in rats receiving alcohol and burn injury may cause an increase in bacterial translocation and their spread to extraintestinal sites.

Epidemiology of unintentional adult injury in a rural population

BACKGROUND

The purpose of this study was to describe the frequency, characteristics, and risk factors of unintentional adult injury in a rural population.

METHODS

We interviewed 1,644 adults representing an all-rural county in Iowa. Analyses used bivariate and multivariable logistic regression.

RESULTS

Participants' mean age was 53 years, and 54% were women. Twenty-three percent (n = 380) of participants reported an injury during the past 12 months, of which four fifths were treated. Overexertion (25%) and falls (22%) caused nearly half the injuries. Women with high levels of depression symptoms had 1.57 times (95% confidence interval, 1.05-2.33) the prevalence of injury occurrence as did women with low levels of depression symptoms. Men with a CAGE score of 2 or more had between 0.98 and 2.56 times (according to the range of values of the relevant odds ratio 95% confidence interval) the prevalence of injury episode of men without this exposure.

CONCLUSION

The association of injury occurrence with alcohol problems is consistent with prior research, but the increased prevalence of injury associated with high levels of symptoms of depression requires further study and explanation.

Exposure to parental tobacco and alcohol use: effects on children's health and development

This review examines three ways in which parental tobacco and alcohol use compromises the physical and mental health of children: 1) direct exposure to the substances; 2) living with parents who may become ill from using these substances; and 3) children's modeling of parental substance use. Implications for prevention, intervention, and public education are discussed, and a reframing of the national dialogue on youth substance abuse is called for.

The use of alcohol and other psychoactive substances by victims of traffic accidents in Greece

Alcohol is one of the main causes of traffic accidents worldwide. Its use decreases significantly the driving ability of an individual as well as the reflexes of a pedestrian increasing in this way the possibilities of their involvement in motor-vehicle accidents. The above possibilities are increased when a psychoactive substance has been taken in combination with alcohol due to their synergistic effect. The Laboratory of Forensic Medicine and Toxicology of the University of Athens is authorized to perform the toxicological investigation of traffic accidents that happen in the major part of Greece. The findings of the toxicological analyses that were performed in our laboratory during the years 1995 to 1997 are classified according to the alcohol concentration and the kind of psychoactive substance detected as well as to the gender and the age of the victims, drivers or pedestrians. The results of the above classification are evaluated and the conclusions regarding alcohol, drugs and traffic accidents in Greece are discussed thoroughly.

Alcohol and all-cause mortality: an overview

The relationship between alcohol consumption and all-cause mortality is J-shaped in most industrialized countries. The J-shape is the result of the combination of adverse and beneficial effects of alcohol consumption. Adverse effects include several types of cancer (oropharyngeal, oesophageal, liver, laryngeal and breast cancer), other diseases of the aerodigestive tract, diseases of the heart (alcoholic cardiomyopathy, haemorrhagic stroke, arrhythmia, hypertension), addiction-related mental disorders, and accidents and injuries. Beneficial effects are for ischaemic heart disease and ischaemic stroke. The exact shape of the all-cause mortality curve in a given region depends upon the proportion of the population consuming alcohol at different levels, especially heavy consumption, and on the prevalence of the disorders named above. Thus regions with a relatively low prevalence of ischaemic cardiovascular disease show almost no benefits of consumption, and an all-cause mortality curve which is almost exponential. Females experience a minimum mortality risk at a level of alcohol intake which is lower than that associated with the minimum risk for men. Similarly, an upturn in mortality risk occurs at lower intake levels for women than for men. At present, there is no satisfactory explanation for the observation that the shape of the mortality curve varies with the consumption level of the cohort under study. Heavier-drinking cohorts tend to display their minimum risk at relatively higher levels of alcohol intake than cohorts with lower alcohol consumption.

The J-shaped curve and changes in drinking habit

The accepted interpretation of the J-shaped curve relating alcohol intake to mortality or coronary heart disease is that the lowest point on the curve (light/moderate drinking) represents optimum exposure to alcohol and that the increased risk in non-drinkers reflects the consequence of sub-optimum exposure. However, non-drinkers, both ex-drinkers and lifelong teetotallers, consistently show an increased prevalence of conditions likely to increase morbidity and mortality compared with occasional or light drinkers. In addition, regular light drinkers tend to have characteristics extremely advantageous to health. Changes take place in alcohol intake in individuals over time, with a strong downward drift from heavy or moderate drinking towards non-drinking, affected to a considerable extent by the accumulation of ill health. Reduction in alcohol intake or giving up drinking is associated with higher rates of new diagnoses than remaining stable in alcohol intake and also with higher rates of both cardiovascular and non-cardiovascular mortality. The use of non-drinkers as a baseline, and failure or inability to adequately take into account the characteristics of subjects in the different alcohol intake categories, exaggerates the risk of coronary heart disease events and all cause mortality in non-drinkers and the benefits of light/moderate alcohol intake.

Comparison of Three Methods to Assess Binge Consumption: One-Week Retrospective Drinking Diary, AUDIT, and Quantity/Frequency

Binge consumption contributes substantially to the occurrence of alcohol-related harm. Despite its importance, binge drinking is not well defined in the literature. The present study examines the proportions of respondents identified as binge drinkers by three separate measures: a 1-week retrospective drinking diary (RD), the Alcohol Use Disorders Identification Test (AUDIT), and a quantity/frequency (QF) question. Overall, AUDIT detected the highest proportion of binge drinkers, followed by QF and RD. There was also good agreement between QF and RD, as well as QF and AUDIT. Ultimately, the measure of choice should be that which provides information most appropriate to the purposes of each study.

Relationships between ambulance transports for alcohol intoxication and assault

OBJECTIVE

To evaluate the association between ambulance transports for assault and those for alcohol intoxication.

METHODS

A retrospective analysis of emergency medical services (EMS) calls was performed. The authors used logistic regression models to compare patients transported for alcohol intoxication with a control group of patients transported for respiratory distress (asthma or shortness of breath) with respect to whether they had been transported on a separate occasion for a chief complaint of assault.

RESULTS

Patients transported for alcohol intoxication had 9 times the risk of transport for assault as compared with the control group (OR = 9.3; 95% CI = 6.4, 13.6). The odds of transport for assault among the alcohol patients increased 17.1% with each alcohol transport (OR = 1.17; 95% CI = 1.14, 1.20) but decreased for the control group (OR = 0.34; 95% CI = 0.26, 0.44). Repeat transports for assault were more common among the alcohol patients than among the control group (OR = 3.3; 95% CI = 1.1, 11.3). The mean number of assault transports was higher among the alcohol patients than among the patients never transported for alcohol intoxication (p < 0.0001).

CONCLUSIONS

Patients transported on multiple occasions for acute alcohol intoxication are at relatively high risk for assault. This risk group should be targeted for focused assault prevention interventions that include components designed to reduce incidents of repeat alcohol intoxication.

Surrogate assessment of coronary artery disease patients' functional capacity

An investigation of the surrogate assessment of coronary artery disease (CAD) patients' functional capacity was conducted using 193 patient and surrogate rater dyads. Mean age of patients and surrogate raters were 60.4 and 54.4 years, respectively. Patients and surrogates independently completed a brief questionnaire that assessed health and psychosocial factors. The Duke Activity Status Index (DASI) was contained in the patients' questionnaire, while a similar form modified to assess patients' functional capacity was imbedded in the surrogates' questionnaire. Results indicated similar psychometric characteristics and clinical validity for patients' self-report and surrogates' ratings, suggesting that the Surrogate Rating Form of the Duke Activity Status Index (DASI-SRF) is a reliable and valid proxy method of assessing patient's functional capacity when this information may not be obtained directly from the patient. Further, while there were no effects of surrogates' health and psychological characteristics on their ratings of patients' functional capacity, in comparison with other surrogates, spouses were more likely to rate patients higher in functional capacity. Exploration of the patient/care provider relationship via concurrent use of the DASI and DASI-SRF is discussed.

High alcohol-related premature mortality in France: concordant estimates from a prospective cohort study and national mortality statistics

This study examines the magnitude of alcohol-related premature death in the French population, which still has the highest average alcohol intake in the world and a relatively low coronary heart disease mortality rate. Two data sources were used: the national mortality data in 1990 and a prospective mortality experience in a cohort of 2,687 middle-aged working men examined in 1980-1985 and followed-up during an average of 9.3 years. In the general population study, alcohol-related premature mortality (35-64 years) was calculated using alcohol-attributable fractions (AAFs) derived from studies of alcohol involvement in deaths from various causes. In the cohort, it was estimated from AAFs and attributable risk using both alcohol exposure prevalence and relative risks of death according to alcohol intake categories. In 1990, estimates of 19.1% and 13.0% of all premature deaths in French men and women were attributed to alcohol. Digestive diseases followed by malignant neoplasms in men and by unintentional injuries in women were major contributors to the total number of alcohol-related premature deaths. In the cohort study, 90 deaths occurred during the follow-up period. The estimation of alcohol-related premature mortality using AAFs was 24.4%. The relative risk of total mortality (adjusted for age, smoking habits, and body mass index) for men who consumed > 60 ml/day of alcohol, compared with those who consumed 0-25 ml/day was 1.9 (95% confidence interval: 1.1-3.5). The consumption of 26-60 ml/day was not associated with reduced risk of mortality, and the adjusted relative risk for this group was 1.3 (95% confidence interval: 0.7-2.5). The estimated attributable risk of premature mortality caused by consumption of > 25 ml/day of alcohol was 29.9%. This study reports the persisting high alcohol-related premature mortality in the French general population, as well as in middle-aged working men. The results suggest that efforts should be paid to reduce further the consumption of alcohol in France.

Non-fatal injuries and the use of psychoactive drugs among young adults in Spain

We compared the prevalence of injuries requiring medical treatment in the general population, in cocaine users and in heroin users, and we studied the factors associated with the occurrence of injuries in these groups, using data from two interview surveys carried out in 1993 in Spain: the National Health Interview Survey, a national representative sample of the non-institutionalized general population, and a survey of a non-probability sample of heroin or cocaine users selected from the community. The subjects included in the study were persons 16-40 years of age in urban areas: 4261 persons from the general population, 369 cocaine users and 215 heroin users. The annual prevalence of injuries requiring medical treatment was 7.9 percent in the general population, 10.8 percent in cocaine users and 35.2 percent in heroin users. There was a statistically significant positive association of injury occurrence (1) among the general population: with male sex, alcohol use, use of tranquillizers/sleeping pills, and the use of antidepressants or stimulants; (2) in cocaine users: with the use of opiates other than heroin; and (3) in heroin users: with alcohol use, the use of tranquillizers/sleeping pills, and the injected route. The only statistically significant negative association was with the amount of cocaine consumed among heroin users. The results suggest that other psychoactive substances besides alcohol are positively associated with injury occurrence, and that cocaine use may contribute to a reduced risk of injuries associated with the use of depressants (alcohol, tranquillizers, heroin).