Rivara F P, Mueller B A, Somes G, Mendoza C T, Rushforth N B, Kellermann A L
Harborview Injury Prevention and Research Center, Seattle, Wash. 98104-2499, USA.
JAMA. 1997 Aug 20;278(7):569-75.
While acute alcohol and illicit drug use are common in homicide and suicide victims, the role of chronic substance use in violent death is unclear.
To measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and use of illicit drugs.
Data obtained from a case-control study of risk factors for homicide and suicide in 3 large metropolitan areas of the United States.
Matched case-control study including 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analyzed by means of conditional logistic regressions in which other potential risk factors for violent death were also considered. OUTCOME AND EXPOSURE MEASURES: Homicide and suicide victims were identified from medical examiner reports in Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information about alcohol or illicit drug use, and history of alcohol-related hospitalization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject were also obtained.
The risks of homicide and suicide associated with alcohol or illicit drug use were elevated, as were the risks of violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users were at increased risk of homicide (odds ratio, 1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8).
Alcohol and illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for non-substance-abusing individuals living in households in which other members abused alcohol or drugs. The concept of the individual at risk of homicide should be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.
虽然急性酒精和非法药物使用在凶杀和自杀受害者中很常见，但慢性物质使用在暴力死亡中的作用尚不清楚。
衡量与酒精使用或慢性滥用以及非法药物使用相关的在家中暴力死亡的风险程度。
从美国3个大城市地区的凶杀和自杀危险因素病例对照研究中获得的数据。
匹配病例对照研究，包括388例凶杀案、438例自杀案以及按年龄、性别、种族、邻里和郡县匹配的同等数量的对照。通过条件逻辑回归分析数据，其中还考虑了暴力死亡的其他潜在危险因素。结果和暴露测量：从田纳西州谢尔比县、华盛顿州金县和俄亥俄州库亚霍加县的法医报告中识别凶杀和自杀受害者。对与死者关系密切的代理受访者进行结构化访谈，以获取有关酒精或非法药物使用以及因受试者饮酒导致的与酒精相关的住院治疗或工作问题的历史信息。还获取了与受试者住在同一所房子里的其他人的酒精使用数据。
与酒精或非法药物使用相关的凶杀和自杀风险升高，与慢性酒精滥用的几个指标相关的暴力死亡风险也升高。此外，与饮酒者同住的非饮酒者凶杀风险增加（比值比，1.7；95%置信区间，0.98 - 3.0），与非法药物使用者同住的非吸毒者凶杀风险大幅增加（比值比，11.3；95%置信区间，4.4 - 28.8）。
酒精和非法药物使用似乎与暴力死亡风险增加有关。对于生活在其他家庭成员滥用酒精或药物家庭中的非物质滥用个体，凶杀风险增加。应扩大凶杀风险个体的概念，不仅包括滥用者，还包括那些因接触他人而可能处于风险中的人。
