Our study results show a steady increase in the rate of female intoxicated trauma patients during the last decade. Recent research shows that alcohol use/misuse among women is increasing12,13. This study is the first to report of a gradual increase in rate of intoxicated traumatic females. However, there is limited data available to compare these results to. Overall, alcohol-attributable injuries are more frequent in males than in females, but the increase in rate of intoxicated traumatic females stands concerning 14.The increase in traumatic events in females can be related to a new change in socioeconomic status of women during the last decade, which directly affects the well-being, mental health, behavior, and quality of life for women 15,16. Also, both sex and gender-related factors are interacting with alcohol use, which impact the risk for development of the behavioral problems and alcohol use disorders 17. For example, women start drinking at a later age yet start to have alcohol-related problems sooner and at lower drinking levels than men17. Alcohol dependent females are more likely to have comorbid psychiatric disorders and are less likely to receive alcohol-related services in their lifetime in comparison to men 18–21. Further studies are needed to investigate reasons behind the increase rate of female sex in intoxicated trauma patients.
We observed the highest rate of alcohol intoxication in women in patients ranging 21 to 23 years of age and who were of white race. This may indicate a great proportion of those intoxicated by alcohol to be female, young, and white. Evidence supports the association of increased estrogen level and increased alcohol use in females, with mixed findings reported in males 22. In addition, many observational studies reported a rise in alcohol consumption during menses when low estrogen levels are present; this is most likely due to hormonal-related mood disruptions 23–25. However, among young females, fluctuating hormonal levels are present and may not accurately reflect the pathophysiology behind female alcohol consumption 22. However, other factors such as stress, social support, and poverty may play a role in age distribution of alcoholic intoxicated women 16. Although there is a controversy, alcohol may have greater effects on females in terms of biomedical damage and impaired performance compared to men which make them more susceptible for traumatic injury26.Focused research to gender related factors associated with alcohol intoxication and development of the effective preventive strategies are needed.
We found a significantly higher rate of self-inflicted trauma in alcoholic intoxicated women. From among the 2.5% of the study population that had reported self-inflicted trauma, women comprised this percentage more than men even though a greater percentage of men suffered from chronic alcohol abuse. This may be due to the increased likelihood of partaking in risk-taking behaviors that may lead to self-infliction after engaging in alcohol use 27. Other factors such as stress, mental health, social support, and poverty may related to the significant higher rate of self-inflicted trauma in alcoholic intoxicated women16. The specific relationship between female alcohol consumption and self-inflicted trauma requires further investigation.
We found a gradual increase in rate of chronic alcoholic abuse with an increase in age. Alcohol involved traffic crashes have been reported as an important cause of trauma and death in all age groups28,29. Also, alcohol consumption increases risk of trauma for all mechanisms of trauma by cognitive impairment and psychomotor dysfunctions like as eye-brain-hand-foot dyscoordination 30,31. Elderly more tends to be more seriously injured than younger drivers in crashes29. Also, an elderly driver with alcoholism is more impaired than an elderly driver without alcoholism after consuming an equivalent dose of alcohol and age may interact with alcoholism to increase driving risk28. Elderly are in higher risk of severe injury in case of motor vehicle crash 28,29. Also, other injuries like hip fractures and head injuries increases with alcohol consumption in elderly 32,33. Data from the National Longitudinal Alcohol Epidemiologic Survey demonstrate that, elderly with alcoholism have three times more risk of major depressive disorder 34. Grabbe et al. reported 16 times more risk of die of suicide in alcoholic elderly 35. The gradual increase in the rate of chronic alcoholics in elderly is an important health care issue that requires more research in order to help develop injury prevention strategies.
This study found a higher mortality risk for intoxicated elderly, especially men. Increased severity of injury in all mechanisms of trauma for intoxicated patients was reported in literature28–30. A study of more than one million drivers involved in motor vehicle crashes revealed a drinking driver is more likely to contribute to increased morbidity and mortality rates compared to that of a nondrinking driver; this may also be related to injury-related variables such as safety belt use, vehicle deformation, vehicle speed, driver age, and vehicle weight 36. Elderly intoxicated patients have additional morbidity and mortality risks considering the general conditions and comorbidities 28,29,33. More strict population-level alcohol consumption policies in situation like driving and population level injury preventive policies (like fall) may result in the reduction of alcohol-related injury 31,37. We found elderly intoxicated men as the group with highest mortality risk after trauma. There is limited data on this topic. More research is needed to investigate and develop preventive strategies for this high-risk group of patients.
This study has several limitations. The retrospective nature of the study prevents any causal conclusion from being made. Missing data was presented for some variables which was less than 5% of cases. Data for this study was extracted from a large national database that involved data from medical records allowing for coding errors to be present. We did not factor potentially important details, such as those regarding the type and extent of trauma injuries, which could affect the results. Although TQP is a nationwide database, the data is not reflecting nationwide data and the rates may be flawed since hospitals enter and exit the TQP database annually and the report of national prevalence for a condition (like alcoholic intoxication) using the database is not possible. Despite these limitations, this study is one of the first that has reported trends of alcoholic intoxication in trauma patients. Also, using a nationwide database that includes information of patients in a broad national geographic representation from across all regions of the country, makes the study suitable to evaluate trauma patients on a national level.