Fatal nontraffic injuries involving alcohol: A metaanalysis

Study objective: Estimates of alcohol involvement in fatal injuries vary widely. For injuries other than those involving motor vehicles, no national data exist and the quality of regional data is limited. This study synthesizes US medical examiner studies of nontraffic fatalities for the purpose of estimating alcohol involvement by injury mechanism and intent. Methods: We reviewed 331 medical examiner studies published between 1975 and 1995 that reported nontraffic injury fatalities. These studies were identified from computerized bibliographic databases and by hand searching of reference lists from 26 review publications and the subject indices of 7 prominent journals. A final total of 65 articles (19.6%) met our inclusion criteria for analysis. National data on motor vehicle fatalities were used for comparison. Results: A total of 7,459 unintentional injury deaths, 28,696 homicide cases, and 19,347 suicide cases were aggregated. The aggregate percentage tested for blood alcohol concentration (BAC) was highest among homicide cases (88.2%), followed by unintentional injury deaths (84.0%) and suicide cases (81.7%). The aggregate percentage determined to be intoxicated (BAC, greater than or equal to 100 mg/dL) was highest among homicide cases (31.5%), followed by unintentional injury deaths (31.0%) and suicide cases (22.7%). Mean and median comparisons produced comparable findings. Fewer than one quarter of the 65 articles reported gender- and age-specific rates. Inconsistent reporting of gender and age-specific rates in fatal nontraffic injuries prevented their analysis by cause of death. Fatally injured motor vehicle drivers, however, demonstrated distinct variation in alcohol involvement by age and gender. Conclusion: This metaanalysis is the first systematic attempt to estimate alcohol involvement in fatal nontraffic injuries at the national level. it demonstrates that alcohol is an important factor in many fatal injuries and that its importance varies by cause of injury.