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The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies
  1. B Kool,
  2. S Ameratunga,
  3. R Jackson
  1. Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
  1. Correspondence to Mrs B Kool, Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand; b.kool{at}


Objective: To appraise the published epidemiological evidence quantifying the risk of falls associated with acute and usual alcohol consumption among young and middle-aged adults.

Design: Systematic review.

Methods: Data sources: searches of electronic databases (eg, Medline, EMBASE, CINAHL, PsycINFO, Scopus), websites of relevant organisations, major injury journals, reference lists of relevant articles, and contact with experts in the field. Inclusion criteria: epidemiological studies with an English language abstract investigating alcohol use as a risk factor (exposure) for unintentional falls or related injuries among individuals aged 25–60 years. Studies were critically appraised using the GATE LITE tool. Meta-analysis was not attempted because of the heterogeneity of the eligible studies.

Results: Four case–control, three cohort and one case–crossover study fulfilled the inclusion criteria. The studies showed an increased risk of unintentional falls among young and middle-aged adults with increasing exposure to alcohol use. However, the magnitude of this risk varied considerably across studies with most estimates being relatively imprecise. Modest evidence of a dose–response relationship with acute alcohol use was observed. The association between usual alcohol use and fall risk was inconclusive, and evidence of a gender difference was inconsistent.

Conclusions: Alcohol use appears to be an important risk factor for falls among young and middle-aged adults. Controlled studies with sufficient power that adjust effect estimates for potential confounders (eg, fatigue, recreational drug use) are required to determine the population-based burden of fall-related injuries attributable to alcohol. This can help inform and prioritise falls prevention strategies for this age group.

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  • Funding 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.

  • Competing interests None.

  • Ethics approval Ethics approval was obtained.

  • Contributions: BK carried out the search, selected included papers, critically appraised the papers, developed the evidence tables, and wrote the initial draft of the paper. RJ and SA were reviewers for included critically appraised papers and contributed substantially to the interpretation of study findings and writing the paper.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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