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Addiction. 2019 Mar;114(3):462-470. doi: 10.1111/add.14477. Epub 2018 Nov 21.

Estimating alcohol-attributable fractions for injuries based on data from emergency department and observational studies: a comparison of two methods.

Author information

1
Public Health Institute, Alcohol Research Group, Emeryville, CA, USA.
2
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
3
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
4
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
5
Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada.
6
Institute of Medical Science, University of Toronto, Toronto, Canada.
7
Department of Psychiatry, University of Toronto, Toronto, Canada.

Abstract

AIM:

To compare the injury alcohol-attributable fractions (AAFs) estimated using emergency department (ED) data to AAFs estimated by combining population alcohol consumption data with corresponding relative risks (RRs).

DESIGN:

Comparative risk assessment.

SETTING AND PARTICIPANTS:

ED studies in 27 countries (n = 24 971).

MEASUREMENTS:

AAFs were estimated by means of an acute method using data on injury cases from 36 ED studies combined with odds ratios obtained from ED case-cross-over studies. Corresponding AAFs for injuries were estimated by combining population-level data on alcohol consumption obtained from the Global Information System on Alcohol and Health, with corresponding RRs obtained from a previous meta-analysis.

FINDINGS:

ED-based injury AAF estimates ranged from 5% (Canada 2002 and the Czech Republic) to 40% (South Africa), with a mean AAF among all studies of 15.4% (18.9% for males and 8.4% for females). Population-based injury AAF estimates ranged from 21% (India) to 51% (Spain and the Czech Republic), with a mean AAF among all country-years of 36.8% (42.5% for males and 22.5% for females). The Pearson correlation coefficient for the two types of injury AAF estimates was 0.09 for the total, 0.06 for males and 0.32 for females.

CONCLUSIONS:

Two methods of estimating the injury alcohol-attributable fractions-emergency department data versus population method-produce widely differing results. Across 36 country-years, the mean AAF using the population method was 36.8%, more than twice as large as emergency department data-based acute estimates, which average 15.4%.

KEYWORDS:

Alcohol-attributable fraction; emergency department; injury; mortality and morbidity; population alcohol consumption; relative risk

PMID:
30347115
PMCID:
PMC6384006
[Available on 2020-03-01]
DOI:
10.1111/add.14477

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