Hospital-recorded road traffic injury admissions and in-hospital mortality before and after alcohol prohibition in Bihar, India: a retrospective comparative study.

OBJECTIVE: To compare hospital-recorded road traffic injury (RTI) admissions, documented alcohol involvement, average monthly record-based rates, and related in-hospital mortality before and after implementation of alcohol prohibition in Bihar, India, using archived records from 2 tertiary care hospitals in Patna. METHODS: A hospital-based retrospective comparative record review was conducted using archived records from Patna Medical College and Hospital and Nalanda Medical College and Hospital. Eligible records of patients aged 16-50 years admitted with RTIs from October 1, 2015, to September 30, 2017, were reviewed. Cases were categorized as pre-prohibition (October 1, 2015-March 31, 2016; 6 months) or post-prohibition (April 1, 2016-September 30, 2017; 18 months). Because total hospital admission denominators were not consistently available, RTI admissions as a proportion of all admissions could not be calculated. To reduce bias from unequal period lengths, average monthly record-based rates were calculated. RESULTS: A total of 232 eligible RTI records were included: 151 in the pre-prohibition period and 81 in the post-prohibition period. The average RTI record rate was 25.2 records/month before prohibition and 4.5 records/month after prohibition. Documented alcohol involvement declined from 100 records (16.7/month) before prohibition to 3 records (0.2/month) after prohibition (p < 0.001). In-hospital deaths were 26 before prohibition and 15 after prohibition, corresponding to 4.3 and 0.8 deaths/month, respectively; however, the mortality proportion among RTI records did not differ significantly between periods (17.2% vs 18.5%; p = 0.805). Motorcycle involvement remained predominant among cases with available vehicle information. CONCLUSIONS: Early hospital-recorded RTI patterns differed between the pre-prohibition and post-prohibition periods, particularly for documented alcohol involvement and average monthly record rates. However, the findings do not establish a causal, current, or long-term equilibrium effect of prohibition because of the retrospective design, absence of total admission denominators, unequal observation periods, routine-record exposure classification, possible seasonal influences, and lack of long-term trend assessment.