Perspectives in Disease Prevention and Health Promotion Alcohol as a Risk Factor for Injuries -- United States

Extensive research and resultant government and public concern has focused on the relationship between excessive alcohol use and highway injuries. Less generally recognized is alcohol's association with other injuries. The following studies are representative of findings on the relationship between alcohol and morbidity and mortality resulting from nonhighway injuries.

The Washington State Department of Social and Health Services conducted a retrospective investigation to determine the epidemiologic features of injuries from falls. Although no control group was studied, alcohol use, as noted on hospital patient records, was found in 10% of 1,740 persons with fall injuries reporting to a large hospital emergency room in 1975. Alcohol was found in 22% of 78 fall "repeaters" (persons who experienced and sought medical care for more than one fall injury during the 1-year study period) (1).

Another study of injury morbidity, based on emergency room visits to a Massachusetts general hospital from October 1966 to September 1967, identified alcohol-positive Breathalyzer* readings of 0.01% and higher among 22% of 620 persons treated for injuries in the home. Positive readings were associated with 56% of 188 persons reporting because of injuries from fights and assaults. Positive readings were found for 9% of a comparison group admitted for non-injuries (2).

An examination of nonhighway injury deaths occurring from 1965 to 1967 in a California county identified blood alcohol concentrations of 0.10% or higher in 37% of 102 such deaths; these concentrations were identified in 60% of the 10 persons who died from falls, and in 64% of Positive readings were found for 9% of a comparison group admitted for non-injuries (2).

An examination of nonhighway injury deaths occurring from 1965 to 1967 in a California county identified blood alcohol concentrations of 0.10% or higher in 37% of 102 such deaths; these concentrations were identified in 60% of the 10 persons who died from falls, and in 64% of the 22 persons who died from burns. Among a comparison group of persons who died suddenly from non-injuries, 18% had detectable blood alcohol concentrations (3). This study and others suggest that careless handling of smoking materials by intoxicated persons is particularly dangerous and contributes to substantial numbers of burn injuries and deaths, as well as property damage (3-5). *Use of trade names is for identification only and does not constitute endorsement by the Public Health Service or the U. S. Department of Health and Human Services.

A study of adult drownings in Baltimore from 1968 to 1971 demonstrated blood alcohol concentrations of 0.03% or higher in 21 (47%) of 45 victims; 81% of the 21 victims with concentrations of 0.03% or greater had levels of at least 0.10% (6).

A later study of injury mortality conducted in New York City from 1974 to 1975 found that 41% of 54 fall victims, 46% of 28 fire victims, and 53% of 19 drowning victims had alcohol concentrations of 0.10% or higher (7). Reported by Environmental Health Svcs Div, Center for Environment Health, CDC.

Editorial Note

Editorial Note: Alcohol is associated with both highway and nonhighway injuries. The recently announced Department of Health and Human Services Secretarial Initiative on Teenage Alcohol Abuse (8) provides an opportunity to reduce both health and social consequences of alcohol abuse through effective mobilization of private, community, and government resources.

Emergency-room health-care providers should consider testing injured persons for alcohol, both to ensure appropriate medical management of injuries and to serve as the first step in treating problem drinking or alcoholism. Passive prevention measures, such as more widespread use of flame-retardant fabrics and smoke detectors, identification and reduction of fall hazards, sanctions directed at drunken boat drivers, and prohibition of alcohol sale and use in recreational areas, should be implemented to protect everyone, including alcohol-impaired persons.

References

1. Center for Environmental Health. Report: Analysis of the causes and prevention of injuries attributed to falls. Atlanta: CDC, October 1977.

2. Wechsler H, Kasey EH, Thum D, Demone HW Jr. Alcohol level and home accidents. Public Health Rep 1969;84:1043-50.

3. Waller JA. Nonhighway injury fatalities. I. The roles of alcohol and problem drinking, drugs and medical impairment. J Chronic Dis 1972;25:33-45.

4. U. S. Consumer Product Safety Commission. Eighth annual flammable fabrics report. Washington, D.C.: U. S. Consumer Product Safety Commission, December 1980.

5. Levine MS, Radford EP. Fire victims: medical outcomes and demographic characteristics. Am J Public Health 1977;67:1077-80.

6. Dietz PE, Baker SP. Drowning: epidemiology and prevention. Am J Public Health 1974; 64: 303-12.

7. Haberman PW, Baden MM. Alcohol, other drugs and violent death. New York: Oxford University Press 1978.

8. CDC. Alcohol-related highway fatalities among young drivers--United States. MMWR 1982; 31: 641-4.

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