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

Abstract

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.

Figure 1:

Flowchart of selection of studies for inclusion in meta-analysis

Figure 2:

Meta-analysis of alcohol-attributable fractions for 15 causes of fatal nontraffic injuries ^a N: Total number of studies and data from states included for a given cause of fatal injury. ^b BAC ≥ 0.10 g/dL: Number of deaths where the involved decedent (or offender in homicide and child maltreatment cases) had Blood Alcohol Concentration (BAC) ≥ 0.10 g/dL or were reported to be alcohol intoxicated. ^c Tested: Number of deaths where the involved decedent (or offender in homicide and child maltreatment cases) had either valid BAC test results or valid measures of alcohol involvement. ^d I²: a statistic that describes the percentage of variation across studies that is due to heterogeneity rather than chance. AAF: Alcohol-Attributable Fraction; CI: Confidence Interval.