Date Published: May 13, 2008
Publisher: Public Library of Science
Author(s): Joel G Ray, Rahim Moineddin, Chaim M Bell, Deva Thiruchelvam, Maria Isabella Creatore, Piotr Gozdyra, Michael Cusimano, Donald A Redelmeier, Barry Pless
Abstract: BackgroundAlcohol is a contributing cause of unintentional injuries, such as motor vehicle crashes. Prior research on the association between alcohol use and violent injury was limited to survey-based data, and the inclusion of cases from a single trauma centre, without adequate controls. Beyond these limitations was the inability of prior researchers to comprehensively capture most alcohol sales. In Ontario, most alcohol is sold through retail outlets run by the provincial government, and hospitals are financed under a provincial health care system. We assessed the risk of being hospitalized due to assault in association with retail alcohol sales across Ontario.Methods and FindingsWe performed a population-based case-crossover analysis of all persons aged 13 years and older hospitalized for assault in Ontario from 1 April 2002 to 1 December 2004. On the day prior to each assault case’s hospitalization, the volume of alcohol sold at the store in closest proximity to the victim’s home was compared to the volume of alcohol sold at the same store 7 d earlier. Conditional logistic regression analysis was used to determine the associated relative risk (RR) of assault per 1,000 l higher daily sales of alcohol. Of the 3,212 persons admitted to hospital for assault, nearly 25% were between the ages of 13 and 20 y, and 83% were male. A total of 1,150 assaults (36%) involved the use of a sharp or blunt weapon, and 1,532 (48%) arose during an unarmed brawl or fight. For every 1,000 l more of alcohol sold per store per day, the relative risk of being hospitalized for assault was 1.13 (95% confidence interval [CI] 1.02–1.26). The risk was accentuated for males (1.18, 95% CI 1.05–1.33), youth aged 13 to 20 y (1.21, 95% CI 0.99–1.46), and those in urban areas (1.19, 95% CI 1.06–1.35).ConclusionsThe risk of being a victim of serious assault increases with alcohol sales, especially among young urban men. Akin to reducing the risk of driving while impaired, consideration should be given to novel methods of preventing alcohol-related violence.
Partial Text: Intentional injury is a widespread cause of death, disability, property damage, demand for emergency medical service, and grief . One major precipitant is interpersonal conflict , whose risk factors include male gender, young adult age, and low socioeconomic status . A person’s risk of intentional injury is not fully explained by these factors, however.
There were 3,903 youths and adults hospitalized due to assault during the 32-mo study period, equivalent to a rate of four per day. Of these, 15 were excluded because they resided outside Ontario, 419 could not be matched to an LCBO outlet by postal code, and 257 cases had extreme outlier LCBO sales data on the index date, the referent date, or both. This resulted in a study cohort of 3,212 cases. The number of patients was generally steady over time, with a peak between July and October of each year (Figure 1). Specifically around the December holidays, while alcohol sales rose considerably, there was a relative decline in assault cases (Figure 1).
We observed a 13% higher risk of being hospitalized for assault with each additional 1,000 l of alcohol sold per day, equivalent to about a doubling of the usual daily sales. At peak times of alcohol sales, the risk was 41% higher, equivalent to about 1.4 additional assaults per day. About one-third of injuries were due to a sharp or blunt weapon, and were significantly associated with alcohol sales. This suggests that the cognitive impairment caused by alcohol is a factor in intentional injuries [8,9], as might be greater mixing of at-risk social groups, such as young men living in urban locations.