Alcohol-related injuries: Evidence for the prevention paradox
Alcohol-related injuries: Evidence for the prevention paradox
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DOI：
10.1370/afm.243
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发表时间：
2005-01-01
影响因子：
4.4
通讯作者：
Vinson, DC
中科院分区：
文献类型：
--
作者：
Spurling, MC;Vinson, DC
目的在特定场合下，随着饮酒的增加，损伤的风险呈指数级增加，但酒精相关损伤主要可归因于大量饮酒的结论可能是正确的，也可能是错误的。预防悖论指出，与个别风险较大的少数人相比，风险较小的大量人可能会导致更多的特定疾病病例。我们试图确定预防悖论在饮酒与伤害关系中的应用程度。方法我们在密苏里州布恩县的所有3个急诊科进行了基于人群的病例对照和病例交叉研究。通过随机数字拨号从2517例急性损伤患者和1856例年龄和性别匹配的对照组中收集数据。结果病例交叉分析中与受伤前6小时内饮酒相关的人群归因分数(PAF)为10.6%，病例对照分析中为8.5%。在病例交叉分析中，由于通常被认为是无害的饮酒(男性少于5杯，女性少于4杯)导致的PAF在病例交叉分析中为4.5%，在病例对照分析中为3.1%。酒精依赖所致PAF的发生率为4.0%。结论酒精依赖对PAF的影响较大，与饮酒场合有关。在因饮酒而引起的PAF中，相当大一部分来自通常被认为是低风险的数量。
PURPOSE The risk of an injury increases exponentially with alcohol consumption on a given occasion, but the conclusion that alcohol-related injuries are attributable primarily to heavy drinking may or may not be correct. The prevention paradox states that a large number of people at small risk may contribute more cases of a particular condition than a smaller number of people who are individually at greater risk. We sought to determine the extent to which the prevention paradox applies in the relationship between alcohol consumption and injury.METHODS We conducted a population-based case-control and case-crossover study in all 3 emergency departments in Boone County, Mo. Data were collected from 2,517 patients with an acute injury and 1,856 age- and sex-matched controls selected by random digit dialing.RESULTS The population attributable fraction (PAF) associated with drinking in the 6 hours before injury-the proportion of injuries that would not have occurred in the absence of drinking-was 10.6% in case-crossover analysis and 8.5% in case-control analysis. The PAF that was due to what is usually considered nonhazardous alcohol consumption (fewer than 5 drinks for men, fewer than 4 for women) was 4.5% in case-crossover analysis and 3.1% in case-control analysis. The PAF that was due to alcohol dependence was 4.0%.CONCLUSIONS Injury is associated more with an occasion of alcohol consumption than with alcohol dependence. A substantial proportion of the PAF that is due to an occasion of alcohol consumption is from what are usually considered low-risk quantities.