Alcohol Screening Scores and Medical Outcomes: Age and Gender Influences

描述（由申请人提供）：尽管有广泛的流行病学证据表明饮酒与健康有关，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于评估患者不良酒精相关医疗结果的风险水平。酒精使用障碍识别测试-消费（AUDIT-C）是一种针对酒精滥用的简短筛查，设计并验证了用于初级保健机构[1-6]。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，这些诊断是慢性饮酒（如肝病、上消化道出血和胰腺炎）7、急性饮酒（如创伤性损伤）8,9以及死亡率10的结果。然而，AUDIT-C评分与女性健康问题之间的关系尚不清楚。此外，研究发现，AUDIT-C评分与医疗结果之间的联系因年龄的不同而有很大差异，但迄今为止研究的样本量相对较小，只允许对三个广泛的年龄组（< 50岁；50-64岁；50- 65岁）进行评估，并且这些年龄与AUDIT-C的相互作用尚未在女性中进行评估。因此，本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已有数据，确定胃肠道（GI）疾病（即肝病、上消化道出血、胰腺炎）、创伤性损伤住院以及可归因于AUDIT-C评分的死亡率的性别和年龄特异性风险。作为退伍军人管理局病人健康经历调查的一部分，2004年对190 000多名退伍军人管理局门诊病人进行了全国抽样审计- c（对妇女和新退伍军人进行了超额抽样；回复率超过71%）。在本研究中，我们建议将这些AUDIT-C评分与VHA国家患者护理数据库（2003-2006）的临床数据、医疗保险数据（2003-2006）以及死亡率数据联系起来。我们将评估因胃肠道疾病、创伤住院以及AUDIT-C评分导致的死亡率的性别和年龄特异性风险。逻辑回归将用于模拟每个结果的几率。协变量（如吸烟、抑郁、收入、种族、教育和婚姻状况）将使用麦克阿瑟风险估计模型添加到未调整的模型中12,13。我们的长期目标是通过三种方式使用本研究产生的风险信息：1)将风险信息纳入针对初级保健医生和直接针对患者的教育/动机干预措施中；2)制作一个基于网络的指南，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；3)寻求资金，以进一步验证审计- c的目的，而不是筛选，目的是评估其作为酒精滥用生命体征的潜力。

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.