Alcohol Research Group, Public Health Institute, Emeryville, California, USA.
Department of Economics, Indiana University School of Liberal Arts at IUPUI, Indianapolis, Indiana, USA.
Alcohol Clin Exp Res. 2021 Oct;45(10):2029-2039. doi: 10.1111/acer.14684. Epub 2021 Aug 23.
Numerous studies of roadside accidents among emergency room patients show elevated risk of injury from acute alcohol consumption, i.e., recent drinking precedes the injury event. The observed effects are large and show a dose-response relationship. In contrast, studies quantifying the association between injury risk and chronic consumption, such as past-year average volume, show lower relative risk estimates than those from acute consumption.
Combining data from 4 waves of US National Alcohol Surveys (NAS) for years 2000-2015 (N = 29,571, 53% overall cooperation rate), we estimated the risk of any past-year injury from past-year volume using logistic regression. This was contrasted with an instrumental variable (IV) analysis utilizing a 2-stage residual inclusion (2SRI) approach to estimate injury risk from volume, which adjusted for unobserved confounders using state beer and spirits tax rates, zip code-level outlet and bar density, and control state status as instruments.
Based on the combined US population surveys and controlling for sociodemographics, using conventional logistic regression, the odds ratios of injury from an average volume of 1, 2, and 5 drinks per day were 1.12 [95% confidence interval: 1.02, 1.24], 1.10 [1.00, 1.22], and 1.04 [0.88, 1.22], respectively. These compared with 1.67 [1.00, 2.78], 2.38 [0.87, 6.54], and 6.98 [0.57, 85.89] using the IV method. The proportion of injury attributed to alcohol also increased in magnitude, from 6.2% [0.3%, 11.9%] using the conventional approach to 17.9% [8.2%, 27.7%] using the IV method.
The association between injury and chronic alcohol consumption may be confounded by unobserved factors, resulting in a possible downward bias of the risk estimate.
许多关于急诊科患者路边事故的研究表明，急性酒精摄入会增加受伤风险，即近期饮酒会导致伤害事件。观察到的影响较大，且呈剂量-反应关系。相比之下，量化损伤风险与慢性饮酒（如过去一年的平均量）之间关联的研究显示，相对风险估计值低于急性饮酒。
我们结合了 2000 年至 2015 年美国国家酒精调查（NAS）的 4 个波次的数据（N=29571，总合作率为 53%），使用逻辑回归估计过去一年的饮酒量与任何过去一年受伤之间的风险。这与利用两阶段剩余纳入（2SRI）方法的工具变量（IV）分析形成对比，该方法利用州啤酒和烈酒税率、邮政编码级别的销售点和酒吧密度以及控制州状态作为工具，调整未观察到的混杂因素，估算了饮酒量与损伤风险之间的关系。
基于美国人群调查并控制了社会人口统计学因素，使用常规逻辑回归，平均每天饮用 1、2 和 5 杯酒的损伤比值比（OR）分别为 1.12[95%置信区间（CI）：1.02，1.24]、1.10[1.00，1.22]和 1.04[0.88，1.22]。相比之下，使用 IV 方法分别为 1.67[1.00，2.78]、2.38[0.87，6.54]和 6.98[0.57，85.89]。使用常规方法归因于酒精的损伤比例为 6.2%[0.3%，11.9%]，而使用 IV 方法则为 17.9%[8.2%，27.7%]。
损伤与慢性酒精摄入之间的关联可能受到未观察到的因素的混杂，导致风险估计值可能存在向下偏差。
