Multicentre Study of Acute Alcohol Use and Non-Fatal Injuries: Data from the WHO Collaborative Study on Alcohol and Injuries/ Etude Multicentrique De la Relation Entre Abus D'alcool et Traumatismes Non Mortels : Donnees Fournies Par Une Etude Collective Menee Par l'OMS Sur le Theme Alcools et traumatismes/Estudio Multicentrico Sobre Consumo Agudo De Alcohol Y Traumatismos No Mortales: Datos De Un Estudio

[TEXT NOT REPRODUCIBLE IN ASCII] Introduction Reports of alcohol use that used the case-crossover design have shown that alcohol use is a strong risk factor for all causes of non-fatal injuries among patients attending emergency departments. (1-4) These reports, along with others that have sampled patients in the general population, have concluded that alcohol use is associated with driving accidents, (5) violence, (6,7) suicide,(8) and injuries such as falls, trips and burns--that is, non-traffic injuries in general. (9-14) The unique feature of the case-crossover study is that this method allows the effect of acute alcohol use to be separated from chronic effects of consumption (such as those that occur in people who abuse alcohol or are dependent on it). (15) Both are matters of great interest to public health policy-makers, such as when trying to establish safe limits for drinking across various situations, (16) and in injury epidemiology. (17) The case-cross-over method seems especially appropriate when studying the risk of non-fatal injury among people who consume only low levels or moderate levels of alcohol, (18) when assessing differences in risk across modes of injury (1) and when determining whether alcoholics may have a different risk of non-fatal injury compared with non-dependent drinkers. (19) Although these issues have been pardally addressed in prior case-crossover reports, (1,4,20) which have found mixed results, an important factor in a detailed analysis of these issues is the small sample size used in most studies, which affects the power of the analysis of the effects on those who consume only small amounts of alcohol and the comparisons that are made across key modifiers of the effects. The WHO collaborative study on alcohol and injuries (21) is a large multicentre survey of injured patients presenting in hospitals worldwide; its data can be used to help circumvent these limitations. The goals of this paper are to report on the risk of non-fatal injury according to levels of acute use of alcohol; thus, looking at a dose-response relationship. We also seek to compare risk estimates for patients who are heavy drinkers and those who are chronic alcoholics across modes of injury. Methods Data from the WHO collaborative study on alcohol and injuries were collected in 2001-02 from emergency departments in Argentina, Belarus, Brazil, Canada, China, the Czech Republic, India, Mexico, Mozambique, New Zealand, South Africa and Sweden. The methods used were similar to those used previously in emergency department studies in a number of countries. (22) Probability samples were drawn from patients admitted within 6 hours of an injury at each site; each shift during each day of the week was represented equally in the sampling. The target sample size was 500 patients from each site. Patients were approached as soon as possible to obtain informed consent for participation in the study. The total sample size of participants aged 18 years or older was 5243 patients, representing a 91% response rate. In their interviews, researchers at two sites (Mozambique and South Africa) did not include the questions required for case-crossover analysis and their data were excluded, leaving a final sample size of 4320 participants. Interviewers were trained and supervised by study collaborators. Interviewers administered a standard 25-minute questionnaire. Further details on the sample have been presented elsewhere. (21) Interview The questionnaire was translated and then back-translated into each language; it included questions on whether the participant reported drinking during the 6 hours before the injury, an estimate of the amount of alcohol consumed during the same 6-hour period in the previous week, an estimate of the number of drinks consumed during each period, and the usual quantity of alcohol consumed and the frequency of alcohol use during the past year. …

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