Alcohol Screening Scores and Medical Outcomes: Age and Gender Influences

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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.