Abstract
BACKGROUND: Primary data collection has established that alcohol causes injuries treated in the emergency department. No comparable data exist for injuries admitted to hospital. Data on the injury risks of heavy drinkers relative to other drinkers also are sparse. METHODS: We estimated (i) whether regular heavy drinkers have higher hospitalized injury risks than other people when alcohol-negative and (ii) how much hospitalized injury risk of regular heavy drinkers and other drinkers rises when alcohol-positive. We combined national alcohol consumption data with alcohol metabolism rates to estimate hours spent alcohol-positive versus alcohol-negative during a year for heavy drinkers versus other people. A literature review provided hospitalized nonfatal injury rates for these groups by alcohol involvement. RESULTS: Relative to other alcohol-negative people aged 18 and older, heavy drinkers have an estimated relative risk of hospitalized injury of 1.4 when alcohol-negative and 4.3 when alcohol-positive. Others have an estimated relative risk of 1.0 when alcohol-negative and 6.8 when alcohol-positive. Thus, alcohol greatly raises injury risk. The excess risk patterns persist for a wide range of sensitivity analysis values. Of hospitalized injuries, an estimated 21% are alcohol-attributable including 36% of assaults. CONCLUSIONS: Drinking alcohol is a major cause of hospitalized injury. Heavy drinkers lead risky lifestyles. They tolerate alcohol better than most drinkers, but their injury risks still triple when they drink. Our approach to attribution is a valuable complement to more costly, more precise approaches that rely heavily on primary data collection. It works for any severity of injury. Applying it only requires an existing alcohol consumption survey plus data on alcohol involvement in targeted injuries.