Open Access Highly Accessed Research article

Associations between heavy episodic drinking and alcohol related injuries: a case control study

Ingeborg Rossow1*, Stig Tore Bogstrand234, Øivind Ekeberg56 and Per Trygve Normann2

Author Affiliations

1 Norwegian Institute for Alcohol and Drug Research, POB 565 Sentrum, Oslo N-0105, Norway

2 Norwegian Institute of Public Health, Division of Forensic Medicine and Drug Abuse Research, PO Box 4404, Nydalen, Oslo N-0403, Norway

3 Emergency Department, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Oslo N-0407, Norway

4 Lovisenberg University College, Lovisenberggt. 15b, Oslo 0456, Norway

5 Department of Acute Medicine, Oslo University Hospital Ullevål, Postboks 4956 Nydalen, Oslo 0424, Norway

6 Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway

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BMC Public Health 2013, 13:1076  doi:10.1186/1471-2458-13-1076

Published: 14 November 2013



Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries.


We applied a case – control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately.


An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox.


There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.

Alcohol; Heavy episodic drinking; Injuries; Accidents; Violence; Case control study; Prevention paradox