The contribution of alcohol to falls at home among working-aged adults
Introduction
The public health impact of unintentional falls is substantial. The published fall-related literature is dominated by studies examining the causes and consequence of these falls among older-age adults. And yet in the United States, unintentional falls are the leading cause of nonfatal injuries resulting in emergency department visits (22%), hospitalizations (24%), and the third leading cause of unintentional injury death in the 25–59 year age group (CDC Wisqars, 2005a, CDC Wisqars, 2005b). A review of Norwegian injury register data found 44% of injuries sustained inside the dwelling among people aged 25–64 years were as a result of falls (Kopjar & Wickizer, 1996). In New Zealand, falls account for a significant burden of injury being responsible for approximately 43% of unintentional injury hospitalizations and 21% of unintentional injury mortality across all age groups (Injury Prevention Research Unit National Injury Query System). Among the working-age population (25–59 years) almost one-third of unintentional falls resulting in-patient admissions or deaths occur at home (Kool et al., 2007).
In New Zealand, entitlement claims for injury compensation over the period 2003–2005 for unintentional falls among working-age people have risen by nearly a third from NZ$61 million to NZ$81 million (Injury Statistics ACC data warehouse, 2005). The impact of injury in this relatively young population may have significant implications for both work productivity and family life (Talbot et al., 2005).
The role of alcohol in road traffic crashes as well as the proportion of crashes attributable to varying amounts of alcohol consumed in the preceding 6 h is well established (Connor et al., 2004). In contrast the role of alcohol in fall-related injuries is unclear. However it is estimated that 7% of the burden of worldwide disability and death related to falls is attributable to alcohol (Room et al., 2005).
Drinking alcohol can result in impaired cognitive and behavioral skills, predisposing an individual to injury (Driscoll et al., 2004, Li et al., 1994, Paljarvi et al., 2005). Alcohol intoxication may also adversely affect a person's physiological response to serious injury by impairing the cardiovascular response to acute blood loss, promoting electromechanical disassociation, and increasing the likelihood of an adverse outcome following a traumatic brain injury (Moore, 2005).
Studies examining the association of alcohol with falls among older age adults have found mixed results with odds ratios for usual alcohol consumption ranging from 0.35 to 1.70 (Mukamal et al., 2004, Nelson et al., 1992, O'Loughlin et al., 1993, Peel et al., 2006, Pluijm et al., 2006, Sorock et al., 2006). Few studies have investigated the association of alcohol with falls at home among people of working age (25–60 years), an age group where serious injury can result in significant implications for both work productivity and family life.
Previous case–control studies examining the role of acute alcohol use in falls have been limited methodologically by the lack of controls representative of the study base and inadequate adjustment for important confounders such as comorbidities, and prescription medication use (Chen et al., 2005, Honkanen et al., 1983, Keegan et al., 2004, Nelson et al., 1992, Sorock et al., 2006).
We report the findings from a case–control study that aimed to address these limitations and investigate the contribution of alcohol to unintentional falls at home among working-age people.
Section snippets
Materials and methods
A population-based case–control study of unintentional falls resulting in primary hospitalization or death among working-aged people was conducted in the Auckland region of New Zealand between July 2005 and July 2006. The region has a population of approximate 1.3 million (32.5% of the national population) and includes urban, suburban, and rural areas (Statistics New Zealand, 2007). The study base comprised people aged 25–60 years of age registered on the General or Māori electoral roll for the
Results
Of the 344 eligible cases identified during the study period, 335 (97.4%) completed interviews, 8(2.3%) declined, and there was one missed case (0.3%). Seven interviews were conducted with a proxy respondent (2%). Of the 1,299 individuals randomly selected from the electoral roll to take part as controls, 570 (56.1%) could not be contacted, and 174 (23.9%) were found to be ineligible when contacted (Fig. 1). Of the 555 who were eligible and contactable, 352 (63.4%) were interviewed. Because the
Discussion
Our findings suggest that drinking in the previous 6 h has a strong and consistent relationship with the risk of unintentional falls at home among working-age people. This relationship remained significant when associations were adjusted for potential confounding factors. Importantly, even low-levels of alcohol consumption were noted to increase the risk of fall-injury at home, with the avoidance of alcohol estimated to reduce the number of these injuries by up to 20%. This is a largely
Acknowledgments
This research was funded and supported by the Accident Compensation Corporation (ACC), Wellington, New Zealand. Views and/or conclusions in this article are those of the authors and may not reflect the position of ACC.
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