Background_Information.docx

Title: Assessing Alcohol Involvement in Fatal Non-Traffic Injuries

Background:

Excessive alcohol use is responsible for about 88,000 deaths in the U.S. each year, including 1 in 10 deaths among working-age adults, and cost the U.S. $249 billion in 2010. Binge drinking (4 or more drinks on an occasion for women; 5 or more drinks on an occasion for men) is the most common form of excessive alcohol use, and is responsible for over half the deaths and three-quarters of the economic costs of excessive drinking. Binge drinking is also associated with a range of health and social problems, including high blood pressure, liver cirrhosis, various types of cancer, motor vehicle traffic crashes, falls, drownings, and drug overdoses. Reducing deaths attributable to excessive alcohol use, including binge drinking, is a health objective in Healthy People 2020 (Substance Abuse-20).

Blood alcohol concentration (BAC) data on persons who have died of injuries are typically, though not always, obtained during death investigations conducted by medical examiners, coroners, or other government officials, and included in state and local databases. BAC data on persons who died in motor vehicle traffic crashes are routinely abstracted from these databases by the Fatality Analysis Reporting System (FARS), which is led by the National Highway Traffic Safety Administration (NHTSA). These data are then used to estimate the proportion of crash deaths that are alcohol-attributable (i.e., the alcohol-attributable fraction (AAF) for motor vehicle crash deaths). There is no similar registry or other centralized database that collects BAC data on all fatal non-traffic unintentional injury deaths (e.g., falls or drownings). It is therefore necessary to conduct a special study (i.e., a meta-analysis) to critically review and synthesize the results of individual studies or reports that have compiled information on alcohol involvement in fatal non-traffic injury deaths to estimate AAFs for these conditions.

The most recent meta-analysis that assessed alcohol involvement in fatal non-traffic injuries was published by Smith, et al. (Smith G, Branas C, Miller, T. Fatal nontraffic injuries involving alcohol: a meta-analysis. Annals of Emergency Medicine 1999; 33(6):659–668). This meta-analysis was based on studies published from 1975 to 1995 that used medical examiner data to assess alcohol-involvement in non-traffic injuries. Using a BAC cut-point of 0.10 g/dL to define alcohol-attributable deaths, Smith, et al. estimated the AAF for deaths due to many types of non-traffic injuries, including drownings (34%); falls (32%); fires and burns (42%); and drug poisonings (29%). However, these estimates are more than 20 years old, and may not reflect potential changes in alcohol involvement in deaths due to some of these injury outcomes.