Borges Guilherme, Cherpitel Cheryl, Mittleman Murray
Dept de Investigac Servicio de Salud, Div de Investigac Epidemiol Sociales, Instituto Nacional de Psiquiatria & Universidad Autonoma Metropolitana-Xochimilco, Calzada Mexico Xochimilco No. 101, Col. San Lorenzo Huipulco, DF, 14370 Mexico.
Soc Sci Med. 2004 Mar;58(6):1191-200. doi: 10.1016/s0277-9536(03)00290-9.
This paper reports a case-crossover analysis in a sample of 961 patients who consulted the emergency department (ED) due to an injury in Santa Clara, California, and in Pachuca, Mexico. In the analysis in which usual alcohol consumption during the last 12 months served as the control value, the estimated relative risk of injury in the hour after alcohol consumption, as compared with no alcohol consumption during that time, was 4.33 (CI, 3.55-5.27). After controlling for alcohol use in the 1-h period before injury, the relative risks for consecutive 1-h periods (2-6 h) before the injury were not significantly greater than one, indicating that the induction time was less than 1 h. The relative risk varied greatly depending on race-ethnicity and acculturation among the Hispanics in Santa Clara, with Mexicans in Pachuca showing the highest risk and the high acculturation group in Santa Clara showing the lowest risk. Violence-related injuries were associated with higher relative risk. Relative risk also varied depending on the presence of alcohol dependence and usual frequency of drunkenness: patients with alcohol dependence and patients with high frequency of usual drunkenness had lower risks than patients without alcohol dependence and with lower self-reported episodes of drunkenness in the last year. When blood alcohol content at ED admission was used instead of self-reported alcohol consumption, similar results were obtained. These findings have important public health consequences. Each episode of alcohol consumption results in an increase in the short-term risk for an injury, especially for a violence-related injury. Patients with the lowest usual involvement with alcohol are subject to a higher elevation in their risk for an injury immediately after alcohol consumption compared to patients who drink more heavily.
本文报告了一项病例交叉分析，该分析针对的是961名因受伤前往加利福尼亚州圣克拉拉市和墨西哥帕丘卡市急诊科就诊的患者。在以过去12个月的日常饮酒量作为对照值的分析中，与饮酒期间未饮酒相比，饮酒后1小时内受伤的估计相对风险为4.33（置信区间，3.55 - 5.27）。在控制受伤前1小时内的饮酒情况后，受伤前连续1小时时间段（2 - 6小时）的相对风险并不显著大于1，这表明诱导时间小于1小时。在圣克拉拉市的西班牙裔人群中，相对风险因种族和文化适应程度而有很大差异，帕丘卡市的墨西哥人风险最高，圣克拉拉市文化适应程度高的群体风险最低。与暴力相关的伤害具有更高的相对风险。相对风险还因是否存在酒精依赖和通常的醉酒频率而有所不同：有酒精依赖的患者和通常醉酒频率高的患者的风险低于无酒精依赖且去年自我报告醉酒次数较少的患者。当使用急诊科入院时的血液酒精含量而非自我报告的饮酒量时，也获得了类似的结果。这些发现具有重要的公共卫生意义。每次饮酒都会导致短期内受伤风险增加，尤其是与暴力相关的伤害。与饮酒较多的患者相比，平时饮酒最少的患者在饮酒后立即受伤的风险升高幅度更大。
