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The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies


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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