Alcohol and illicit drug abuse and the risk of violent death in the home
F. P. Rivara, B. A. Mueller, G. Somes, C. T. Mendoza, N. B. Rushforth and A. L. Kellermann
Harborview Injury Prevention and Research Center, Seattle, Wash. 98104-2499, USA.
CONTEXT: While acute alcohol and illicit drug use are common in homicide
and suicide victims, the role of chronic substance use in violent death is
unclear. OBJECTIVE: To measure the magnitude of risk of violent death in
the home associated with alcohol use or chronic abuse and use of illicit
drugs. DATA SOURCES: Data obtained from a case-control study of risk
factors for homicide and suicide in 3 large metropolitan areas of the
United States. DESIGN: Matched case-control study including 388 homicide
cases, 438 suicide cases, and equal numbers of controls matched for age,
sex, race, neighborhood, and county. Data were analyzed by means of
conditional logistic regressions in which other potential risk factors for
violent death were also considered. OUTCOME AND EXPOSURE MEASURES: Homicide
and suicide victims were identified from medical examiner reports in Shelby
County, Tennessee; King County, Washington; and Cuyahoga County, Ohio.
Structured interviews were conducted with proxy respondents close to the
decedents to obtain information about alcohol or illicit drug use, and
history of alcohol-related hospitalization or trouble at work because of
drinking by the subject. Data about alcohol use by others living in the
same house as the subject were also obtained. RESULTS: The risks of
homicide and suicide associated with alcohol or illicit drug use were
elevated, as were the risks of violent death associated with several
indicators of chronic alcohol abuse. In addition, nondrinkers living in a
home with alcohol users were at increased risk of homicide (odds ratio,
1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals
residing in homes with illicit drug users were at greatly increased risk of
homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8).
CONCLUSIONS: Alcohol and illicit drug use appear to be associated with an
increased risk of violent death. The risk of homicide was increased for
non-substance-abusing individuals living in households in which other
members abused alcohol or drugs. The concept of the individual at risk of
homicide should be broadened to include not only the abuser but also those
who may be at risk because of their exposure to others.
Increases in Age-Group-Specific Injury Mortality--United States, 1999-2004
JAMA 2008;299:515-516.
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Houry et al.
J Interpers Violence 2006;21:1483-1492.
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Galvani
Violence Against Women 2006;12:641-662.
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Harris et al.
Arch Pediatr Adolesc Med 2006;160:74-81.
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Chu and Kraus
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Mokdad et al.
JAMA 2004;291:1238-1245.
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Pridemore
Homicide Studies 2003;7:182-205.
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Dube et al.
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Firearms and Suicide
Brent
Ann. N. Y. Acad. Sci. 2001;932:225-240.
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Allgulander and Nilsson
Am. J. Psychiatry 2000;157:244-247.
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Wintemute et al.
NEJM 1999;341:1583-1589.
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Borowsky and Ireland
Arch Pediatr Adolesc Med 1999;153:1170-1176.
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