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 together

Abstract

Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol consumption, but much of the injury literature employs usual consumption habits to assess risk instead. An analysis of the acute dose-response relationship between alcohol and injury is warranted to generate single occasion- and dose-specific relative risks. A systematic literature review and meta-analysis was conducted to fill this gap. Linear and best-fit first-order model were used to model the data. Usual tests of heterogeneity and publication bias were run. Separate meta-analyses were run for motor vehicle and non-motor vehicle injuries, as well as case-control and case-crossover studies. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents, the odds ratio increases by 1.24 (95% CI: 1.18-1.31) per 10-g in pure alcohol increase to 52.0 (95% CI: 34.50-78.28) at 120 g. For non-motor vehicle injury, the OR increases by 1.30 (95% CI: 1.26-1.34) to an OR of 24.2 at 140 g (95% CI: 16.2-36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI: 1.22-1.55). Efforts to reduce drinking both on an individual level and a population level are important. No level of consumption is safe when driving and less than 2 drinks per occasion should be encouraged to reduce the risk of injury.

Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Figures

Figure 1

Results of the systematic review of the relationship between alcohol and injury.

Figure 2

Forest plot for studies of non-motor vehicle accidents only and estimated relative risks associated with a 10 g/day increase in alcohol consumption: Estimates were derived from a random effects linear model.

Figure 3

Forest plot for studies of motor vehicle accidents only and estimated relative risks associated with a 10 g/day increase in alcohol consumption: Estimates were derived from a random effects linear model.

Figure 4

Dose-response curve for the amount of alcohol consumed 3 hours prior and the odds of non-motor vehicle accident injury.

Figure 5

Dose-response curve for the amount of alcohol consumed 3 hours prior and the odds of motor vehicle accident injury.