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The risk of an injury increases exponentially with alcohol consumption on a
given occasion, but the conclusion that alcohol-related injuries are
attributable primarily to heavy drinking may or may not be correct. The
prevention paradox states that a large number of people at small risk may
contribute more cases of a particular condition than a smaller number of people
who are individually at greater risk. We sought to determine the extent to which
the prevention paradox applies in the relationship between alcohol consumption
We conducted a population-based case-control and case-crossover study in all 3
emergency departments in Boone County, Mo. Data were collected from 2,517
patients with an acute injury and 1,856 age- and sex-matched controls selected
by random digit dialing.
The population attributable fraction (PAF) associated with drinking in the 6
hours before injury—the proportion of injuries that would not have occurred in
the absence of drinking—was 10.6% in case-crossover analysis and 8.5% in
case-control analysis. The PAF that was due to what is usually considered
nonhazardous alcohol consumption (fewer than 5 drinks for men, fewer than 4 for
women) was 4.5% in case-crossover analysis and 3.1% in case-control analysis.
The PAF that was due to alcohol dependence was 4.0%.
Injury is associated more with an occasion of alcohol consumption than with
alcohol dependence. A substantial proportion of the PAF that is due to an
occasion of alcohol consumption is from what are usually considered low-risk
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