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将饮酒与健康联系起来，但很少有研究评估临床实践中采用的有效酒精筛查问卷是否可用于评估患者酒精相关不良医疗结局的风险水平。酒精使用障碍识别测试-消费（AUDIT-C）是一个简单的屏幕酒精滥用设计和验证用于初级保健设置1 -6。对于男性来说，初步证据将AUDIT-C评分与随后的医学诊断联系起来，这些诊断是长期饮酒的后果（例如，肝病、上消化道出血和胰腺炎）7，和急性酒精使用（例如，创伤性损伤）8，9，以及死亡率10。然而，AUDIT-C评分与女性健康问题之间的关联尚不清楚。此外，研究发现，AUDIT-C评分和医疗结果之间的联系因年龄而异10，11，但迄今为止研究中相对较小的样本量仅允许评估三个广泛的年龄组（< 50; 50-64; > 65），并且这些年龄X AUDIT-C相互作用尚未在女性中进行评估。因此，本R 03研究的目的是确定胃肠道（GI）疾病的发病和住院的性别和年龄特异性风险（即，肝病、上消化道出血、胰腺炎）、因创伤性损伤住院以及归因于AUDIT-C评分的死亡率，使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。作为VHA患者健康经历调查（SHEP）的一部分，2004年对超过190 000名VHA门诊患者进行了全国抽样（对妇女和新返回的退伍军人进行了过度抽样;答复率超过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）中的临床数据、医疗保险数据（2003-2006）和死亡率数据联系起来。我们将估计性别和年龄特异性GI疾病发作和住院、创伤住院和AUDIT-C评分导致的死亡风险。将使用逻辑回归对每种结局的几率进行建模。协变量（例如，吸烟、抑郁、收入、种族、教育和婚姻状况）将被添加到使用风险估计的麦克阿瑟模型的未调整模型中12，13。我们的长期目标是以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/激励干预措施中; 2）产生基于网络的指南，以帮助临床医生解释AUDIT-C评分，并为特定患者提供各种结局的风险估计;和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酒精相关发病率和死亡率风险的生命体征或比例标志物，并促进和激励改善对整个酒精滥用范围的管理，从饮酒超过推荐限制到依赖。根据性别和年龄定制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，并为与患者讨论酒精消费的健康相关风险提供证据基础。

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.