Alcohol Screening Scores and Medical Outcomes: Age and Gender Influences

酒精筛查分数和医疗结果：年龄和性别的影响

• 批准号: 7387264
• 负责人: Alex Sox-Harris
• 金额: $ 7万
• 依托单位: PALO ALTO VETERANS INSTIT FOR RESEARCH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-15 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7387264
• 关键词: Acute; Advisory Committees; Age; Alcohol consumption; Alcohol dependence; Alcohols; Arrhythmia; Behavior; Blood Pressure; Cardiomyopathies; Cardiovascular system; Characteristics; Clinical; Clinical Data; Clinical Markers; Condition; Consumption; Counseling; Data; Databases; Dementia; Dependence; Development; Diagnosis; Early identification; Education; Ensure; Evaluation; Feedback; Female; Funding; Future; Gender; Goals; Guidelines; Head and Neck Cancer; Health; Health Surveys; Heavy Drinking; Hemorrhage; Hospitalization; Hypertension; Income; Injury; Institute of Medicine (U.S.); Intervention; Laboratory Markers; Link; Lipids; Liver diseases; Logistic Regressions; Malignant Neoplasms; Marital Status; Medical; Medicare; Mental Depression; Modeling; Monitor; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; Online Systems; Outcome; Outpatients; Pancreatitis; Patient Care; Patients; Physicians; Physiological; Population; Preventive; Primary Care Physician; Primary Health Care; Provider; Purpose; Questionnaires; Race; Rate; Research; Research Personnel; Risk; Risk Estimate; Risk Factors; Risk Marker; Sample Size; Sampling; Score; Screening Result; Screening procedure; Serum; Services; Severities; Smoking; Specialist; Stroke; Surveys; Symptoms; Testing; Time; Training and Education; Trauma; Uncertainty; Validation; Veterans; Woman; age group; alcohol misuse; alcohol use disorder; attributable mortality; base; behavioral health; cardiovascular risk factor; chronic alcohol ingestion; design; drinking; drinking behavior; experience; follow-up; gastrointestinal; gastrointestinal function; health administration; high risk drinking; improved; instrument; interest; male; men; mortality; motivational intervention; response; sex; size

DESCRIPTION (provided by applicant): Despite extensive epidemiological evidence linking alcohol consumption and health, few studies have evaluated whether validated alcohol screening questionnaires employed in clinical practice can be used to assess patients' level of risk for adverse alcohol-related medical outcomes. The Alcohol Use Disorders Identification Test- Consumption (AUDIT-C) is a brief screen for alcohol misuse designed and validated for use in primary care settings1-6. For men, preliminary evidence links AUDIT-C scores to subsequent medical diagnoses that are the consequences of both chronic alcohol use (e.g., liver disease, upper GI bleeding, and pancreatitis) 7, and acute alcohol use (e.g., traumatic injury)8, 9, as well as to mortality10. However, the association between AUDIT-C scores and health problems in women is unknown. Also, research has found that the link between AUDIT-C scores and medical outcomes varies substantially by age10, 11, but the relatively small sample sizes in studies to date have permitted only evaluation of three broad age groups (< 50; 50-64; > 65), and these age X AUDIT-C interactions have not been evaluated in women. Therefore, the aims of this R03 study are to determine the sex and age-specific risks of onset and hospitalization for gastrointestinal (GI) conditions (i.e., liver disease, upper GI bleeding, pancreatitis), hospitalization for traumatic injury, as well as mortality attributable to AUDIT-C scores using pre-existing data from a national sample of male and female patients from the Veterans Health Administration (VHA). As part of the VHA Survey of Health Experiences of Patients (SHEP), the AUDIT-C was completed by a national sample of over 190,000 VHA outpatients in 2004 (over-sampled for women and newly returning veterans; response rate over 71%). In this study, we propose to link these AUDIT-C scores to clinical data in the VHA's National Patient Care Database (2003-2006), Medicare data (2003-2006), and to mortality data. We will estimate the sex and age specific risks for onset and hospitalization for GI conditions, hospitalization for trauma, and mortality attributable to AUDIT-C scores. Logistic regression will be used to model odds of each outcome. Covariates (e.g., smoking, depression, income, race, education, and marital status) will be added to the unadjusted models using the MacArthur Model of risk estimation12, 13. Our long-term goal is to use the risk information produced by this study in three ways: 1) To incorporate the risk information into educational/motivational interventions targeted at both primary care physicians and directly to patients; 2) To produce a web-based guide to aid clinicians in the interpretation of AUDIT-C scores and to provide risk estimates of various outcomes for specific patients; and 3) To seek funding for further validation of the AUDIT-C for purposes other than screening, with the goal of evaluating its potential as an alcohol misuse vital sign. The proposed research will calibrate the AUDIT-C so that it can be used by clinicians and clinical researchers as a vital sign or scaled marker of risk for alcohol-related morbidity and mortality, and to facilitate and motivate improved management of the entire spectrum of alcohol misuse, from drinking above recommended limits to dependence. Sex and age-tailored risk information can persuade clinicians that a patient's alcohol misuse is medically-relevant and provide an evidence-base for conversations with patients about the health- related risks of their alcohol consumption.

描述(申请人提供)：尽管有广泛的流行病学证据将饮酒与健康联系起来，但很少有研究评估临床实践中使用的有效酒精筛查问卷是否可以用来评估患者对与酒精有关的不良医疗结果的风险水平。酒精使用障碍识别测试-消费(AUDIT-C)是为初级保健环境1-6使用而设计和验证的酒精滥用的简短筛查。对于男性，初步证据将AUDIT-C评分与随后的医学诊断联系起来，这些诊断既是长期饮酒(例如肝病、上消化道出血和胰腺炎)7的后果，也是急性饮酒(例如创伤性损伤)8、9以及死亡10的后果。然而，AUDIT-C分数与女性健康问题之间的联系尚不清楚。此外，研究发现，AUDIT-C评分和医疗结果之间的联系在10岁和11岁之间有很大差异，但迄今为止研究中相对较小的样本量只允许对三个广泛的年龄组(50岁；50岁-；65岁)进行评估，而这些年龄X的AUDIT-C交互作用尚未在女性中进行评估。因此，这项R03研究的目的是利用来自退伍军人健康管理局(VHA)的全国男性和女性患者样本的预先存在的数据，确定因胃肠道(GI)疾病(即肝病、上消化道出血、胰腺炎)而发病和住院的性别和年龄特定的风险、因创伤住院以及可归因于AUDIT-C评分的死亡率。作为VHA患者健康体验调查(SHEP)的一部分，AUDIT-C在2004年完成了全国超过190,000名VHA门诊患者的抽样(对妇女和新回来的退伍军人进行了过度抽样；回应率超过71%)。在这项研究中，我们建议将这些AUDIT-C评分与VHA的国家患者护理数据库(2003-2006)、医疗保险数据(2003-2006)和死亡率数据中的临床数据联系起来。我们将评估特定性别和年龄的胃肠道疾病的发病和住院风险、创伤住院风险和可归因于AUDIT-C评分的死亡率。Logistic回归将被用来对每种结果的几率进行建模。协变量(如吸烟、抑郁、收入、种族、教育和婚姻状况)将被添加到使用麦克阿瑟风险估计模型12、13的未调整模型中。我们的长期目标是以三种方式使用这项研究产生的风险信息：1)将风险信息结合到针对初级保健医生和直接针对患者的教育/动机干预中；2)制作基于网络的指南，以帮助临床医生解释AUDIT-C评分，并为特定患者提供各种结果的风险估计；以及3)寻求资金，以进一步验证AUDIT-C用于筛查以外的目的，目的是评估其作为酒精滥用生命体征的潜力。 拟议的研究将校准AUDIT-C，以便临床医生和临床研究人员可以将其用作与酒精相关的发病率和死亡率的生命体征或风险标记物，并促进和激励改善对酒精滥用的整个范围的管理，从饮酒超过建议的限度到依赖。针对性别和年龄量身定做的风险信息可以说服临床医生，患者的酒精滥用与医学相关，并为与患者就饮酒的健康相关风险进行对话提供证据基础。