Risk of injury in the u.s. general population: Data from the 1995-2010 national alcohol surveys

Little is known of alcohol's association with risk of injury outside of ER patient samples. Relative risk (RR) of injury from drinking within six hours prior to the event was analyzed using case-crossover analysis based on respondents' usual frequency of drinking in four (1995-2010) National Alcohol Surveys (n=4819). RR was 0.90 (NS) for the total injured, 1.45 (p=0.001) for ER-treated injured, 0.73 (p<.01) for those treated elsewhere and 1.01 (NS) for non-treated injured. Risk was significantly elevated (p<0.01) for those 18-30 (RR=1.43), those high on risk taking (RR=1.45), those positive on the RAPS4 as a measure of alcohol dependence (RR=2.37), and those whose injuries were related to motor vehicle accidents (MVAs) (RR=2.61) or lacerations (RR=2.05). For those reporting ER-treated injuries, significant effect modification (at p< 0.01) was found for age 18-30 (RR=2.29), medium/high risk taking (RR = 1.54), RAPS4 positive (RR=3.69), and MVAs (RR=3.79), and (at p< 0.05) for lacerations (RR=2.60). Data suggest alcohol plays a larger role in injuries for which ER treatment is sought than for other injuries, but risk is not uniform across all causes of injury. Higher risk for injuries treated in the ER may be related to severity of injury, and additional studies in general populations which take into account intensity of exposure to alcohol prior to injury, as well as recall bias (by eliciting data on the proximity of the event to the time of the respondent interview), are necessary for determining unbiased estimates of the RR of injury from drinking.