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.