Temporal and spatial patterns in the rate of alcohol withdrawal syndrome in a defined community
Introduction
Alcohol withdrawal syndrome (AWS) is a hallmark of alcohol dependence (American Psychiatric Association, 2000). It is well known that not all heavy drinkers develop alcohol dependence, which implies an alteration in drinking behavior to alleviate withdrawal symptoms and a need for markedly increased amounts of alcohol to achieve intoxication (alcohol tolerance) according to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000). Seizures, disordered perceptions, and delirium tremens are the most severe manifestations of AWS. These manifestations, particularly the latter, are potentially life-threatening conditions. There are reports in the literature regarding the pathogenesis (Suwaki et al., 2001); clinical manifestations (Barrio et al., 2004, Monte et al., 2009, Williams et al., 2001); treatment (Ntais et al., 2005, Williams and McBride, 1998); and short-term prognosis (Khan et al., 2008, Monte et al., 2010, Puerta Louro et al., 2006) of AWS. However, there have been few reports about the epidemiology of AWS. Patients with AWS are generally middle-aged men (Foy and Kay, 1995, Gippini Pérez et al., 1990, Puerta Louro et al., 2006, Wetterling et al., 2001, Wojnar et al., 2001). Ethnicity may also play a role in the risk for AWS (Chan et al., 2009, Margolis et al., 2008). The genetic predisposition to alcohol dependence and AWS has been extensively studied in both mice (Belknap et al., 2008, Crabbe et al., 2006) and humans (Treutlein et al., 2009, van Munster et al., 2007). However, there are no reports regarding the potential variations in the geographical distribution of cases of AWS and the potential association of AWS with sociodemographic factors. Furthermore, there are no previous reports on inter- and intra-annual trends in the rate of AWS.
Spain is among the leaders in Europe in terms of alcohol consumption, with a per capita annual rate of nearly 10 L of pure alcohol consumption (World Health Organization, 2004). Galicia is an autonomous region in northwest Spain with a per capita annual alcohol consumption rate that is 40% higher than the national average and a high prevalence of alcohol consumption and abuse (Mateos et al., 2002). Thus, AWS is a common reason for hospital admission in Galicia and a frequent comorbidity in patients admitted to hospitals (Gippini Pérez et al., 1990). There is an unconfirmed clinical impression that the rate of AWS varies throughout the year, that the rate varies among areas, and that most of patients with AWS share a similar sociodemographic profile. The present ecological study was, therefore, aimed at investigating temporospatial trends in the rate of AWS in this defined community and potentially associated sociodemographic factors.
Section snippets
Study design
In this ecological study, we studied the temporal (inter- and intra-annual) trends of the rate of AWS, the distribution per district, and the correlation with sociodemographic variables within respective districts over a defined period (1996–2006) in Galicia, Spain. The study was performed according to the current Helsinki Declaration and strictly followed the Spanish regulations for this type of study.
Setting
The Spanish region of Galicia is located in the northwest of the Iberian Peninsula in
Basic demographic description
Of a total of 7,195 episodes of AWS, 6,113 (85%) occurred in men. The median age was 49 years (interquartile range, 41–60 years; range, 17–98 years); age was similar in men (median, 49 years) and in women (median, 50 years).
Temporal trends in the rate of AWS
The frequency of AWS episodes was fairly stable during the study period, ranging from 606 to 720 episodes per year, with a median of 661 episodes per year.
The intra-annual distribution of AWS episodes is represented in Fig. 2. The frequency of AWS episodes tended to be
Discussion
The present study indicates that the rate of severe AWS is independently associated with a low education level in this defined population. This association underlies the uneven geographical distribution and clustering of AWS rates in this defined community. The present study also shows that the intra-annual distribution of AWS was not uniform, and that cases of AWS tended to occur in the summer months. Finally, our results confirm that AWS occurs predominantly in middle-aged men. Taken
Acknowledgments
The authors are grateful for the collaboration with Adolfo Galvez (Spanish National Institute of Statistics) and members of the Alcohol and Alcoholism Interest Group of the Galician Society of Internal Medicine. F.G. was supported by a grant (BAE) from the Instituto de Salud Carlos-III (Spanish Ministry of Science).
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Conflict of interest: none to be disclosed.