ABSTRACT
AIM: To analyze the severity of automotive injuries associated with blood alcohol concentration (BAC) in increments of 0.01%. DESIGN/SETTING: Epidemiological study using the Fatality Analysis Reporting System. PARTICIPANTS: All people in US fatal automotive accidents, 1994-2008 (n = 1 495 667). MEASUREMENTS: The ratio of serious: non-serious injuries for drivers, by BAC. FINDINGS: Accident severity increases significantly even when the driver is merely 'buzzed', a finding that persists after standardization for various confounding factors. Three mechanisms mediate between buzzed driving and high accident severity: compared to sober drivers, buzzed drivers are significantly more likely to speed, to be improperly seatbelted and to drive the striking vehicle. In addition, there is a strong 'dose-response' relationship for all three factors in relation to accident severity (e.g. the greater the BAC, the greater the average speed of the driver and the greater the severity of the accident). CONCLUSIONS: The severity of life-threatening motor vehicle accidents increases significantly at blood alcohol concentrations (BACs) far lower than the current US limit of 0.08%. Lowering the legal limit could save lives, prevent serious injuries and reduce financial and social costs associated with motor vehicle accidents.
Subject(s)
Accidents, Traffic/mortality , Alcoholic Intoxication/blood , Automobile Driving/statistics & numerical data , Ethanol/blood , Wounds and Injuries/mortality , Accidents, Traffic/statistics & numerical data , Alcohol Drinking/adverse effects , Alcohol Drinking/blood , Alcohol Drinking/epidemiology , Alcoholic Intoxication/epidemiology , Automobile Driving/legislation & jurisprudence , Automobiles/statistics & numerical data , Cognition/drug effects , Confounding Factors, Epidemiologic , Dose-Response Relationship, Drug , Epidemiologic Studies , Ethanol/adverse effects , Humans , Injury Severity Score , Risk Factors , Seat Belts/statistics & numerical data , Time Factors , United States/epidemiologyABSTRACT
AIM: To test whether alcohol is a risk factor for sudden infant death syndrome (SIDS). DESIGN AND SETTING: US epidemiological study using computerized death certificates, linked birth and infant death dataset, and Fatality Analysis Reporting System. PARTICIPANTS: All SIDS cases (n = 129,090) and other infant deaths (n = 295,151) from 1973-2006; all persons involved in late-night alcohol-related crashes (n = 135,946) from 1994-2008. MEASUREMENTS: Three measures were used: the expected number of deaths on New Year versus the observed number (expected values were determined using a locally weighted scatterplot smoothing polynomial), the average number of weekend deaths versus the average number of weekday deaths, and the SIDS death rate for children of alcohol-consuming versus non-alcohol-consuming mothers. FINDINGS: These measures indicate that the largest spikes in alcohol consumption and in SIDS (33%) occur on New Year, alcohol consumption and SIDS increase significantly on weekends, and children of alcohol-consuming mothers are much more likely to die from SIDS than are children of non-alcohol-consuming mothers. CONCLUSIONS: Alcohol consumption appears to be a risk factor for sudden infant death syndrome, although it is unclear whether alcohol is an independent risk factor, a risk factor only in conjunction with other known risk factors (like co-sleeping), or a proxy for other risk factors associated with occasions when alcohol consumption increases (like smoking). Our findings suggest that caretakers and authorities should be informed that alcohol impairs parental capacity and might be a risk factor for sudden infant death syndrome; in addition, future research should further explore possible connections between sudden infant death syndrome and alcohol.
Subject(s)
Accidents, Traffic/mortality , Alcohol Drinking/epidemiology , Chronology as Topic , Death Certificates , Sudden Infant Death/epidemiology , Child , Child, Preschool , Epidemiologic Studies , Female , Holidays/statistics & numerical data , Humans , Infant , Infant Care/standards , Infant, Newborn , Male , Maternal Behavior/drug effects , Pregnancy , Risk Factors , Seasons , Sudden Infant Death/etiology , Time Factors , United States/epidemiologyABSTRACT
This paper poses three questions: (1) Does mortality from natural causes spike around Christmas and New Year? (2) If so, does this spike exist for all major disease groups or only specialized groups? (3) If twin holiday spikes exist, need this imply that Christmas and New Year are risk factors for death? To answer these questions, we used all official U.S. death certificates, 1979-2004 (n = 57,451,944) in various hospital settings to examine daily mortality levels around Christmas and New Year. We measured the Christmas increase by comparing observed deaths with expected deaths in the week starting on Christmas. The New Year increase was measured similarly. The expected number of deaths was determined by locally weighted regression, given the null hypothesis that mortality is affected by seasons and trend but not by holidays. On Christmas and New Year, mortality from natural causes spikes in dead-on-arrival (DOA) and emergency department (ED) settings. There are more DOA/ED deaths on 12/25, 12/26, and 1/1 than on any other day. In contrast, deaths in non-DOA/ED settings display no holiday spikes. For DOA/ED settings, there are holiday spikes for each of the top five disease groups (circulatory diseases; neoplasms; respiratory diseases; endocrine/nutritional/metabolic diseases; digestive diseases). For all settings combined, there are holiday spikes for most major disease groups and for all demographic groups, except children. In the two weeks starting with Christmas, there is an excess of 42,325 deaths from natural causes above and beyond the normal winter increase. Christmas and New Year appear to be risk factors for deaths from many diseases. We tested nine possible explanations for these risk factors, but further research is needed.
