Department of Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Canada.
Alcohol Clin Exp Res. 2012 Oct;36(10):1827-34. doi: 10.1111/j.1530-0277.2012.01785.x. Epub 2012 May 7.
Alcohol consumption causes motor vehicle accident (MVA) injury in a dose-response fashion. However, the relationship between how this risk is different with respect to fatal and nonfatal outcomes is not clear. A meta-analysis has already been completed for alcohol consumption and nonfatal MVA injury, but none exists for fatal injury. Thus, an analysis of the acute dose-response relationship between alcohol and motor vehicle injury death is warranted to generate single occasion- and dose-specific relative risks for the first time.
A systematic literature review and inverse-variance weighted, random effects meta-analysis were conducted to fill this gap. Fractional polynomial regression was used to model the dose-response relationship. Usual tests of heterogeneity and publication bias were run.
Five studies meeting the inclusion criteria of this analysis were selected. At all levels of blood alcohol concentration (BAC), the odds ratio (OR) of fatal motor vehicle injury was significant. Overall, the 5 combined studies yielded an OR of fatal injury of 1.74 (95% CI: 1.43-2.14) for every 0.02% increase in BAC. At 0.08, the legal limit in most countries, the OR was 13.0 (95% CI: 11.1-15.2).
This study is able to definitively show and quantify, for the first time, the significantly increased OR for fatal motor vehicle injury. This analysis showed some evidence of both study heterogeneity and publication bias, likely due to the increased variation we could expect from a small study number. The alcohol-caused fatal motor vehicle injury literature is sparse with respect to dose-response information. More studies investigating this relationship and other injury types are recommended in this area to be able to calculate stable estimates of risk overall and by injury type specifically.
酒精摄入与车祸损伤呈剂量-反应关系。然而，这种风险在致命性和非致命性结局方面的差异关系尚不清楚。已有酒精摄入与非致命性车祸损伤的荟萃分析，但没有针对致命性损伤的分析。因此，有必要分析酒精与机动车损伤死亡的急性剂量-反应关系，以首次生成单次和特定剂量的相对风险。
进行了系统的文献综述和逆方差加权、随机效应荟萃分析，以填补这一空白。使用分数多项式回归来构建剂量-反应关系模型。进行了常规的异质性和发表偏倚检验。
选择了符合本分析纳入标准的五项研究。在所有血液酒精浓度（BAC）水平下，致命性机动车损伤的比值比（OR）均具有统计学意义。总体而言，5 项联合研究的结果显示，BAC 每增加 0.02%，致命性损伤的 OR 为 1.74（95%可信区间：1.43-2.14）。在 0.08 时，大多数国家的法定上限，OR 为 13.0（95%可信区间：11.1-15.2）。
本研究首次能够明确并量化酒精摄入与致命性机动车损伤之间的显著增加的 OR。本分析表明存在研究异质性和发表偏倚的一些证据，这可能是由于研究数量较少导致的变异增加。关于剂量-反应信息的酒精引起的致命性机动车损伤文献稀少。建议在该领域进行更多的研究，以调查这种关系和其他损伤类型，以便能够总体和具体按损伤类型计算风险的稳定估计值。
