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Addiction. 2016 Nov;111(11):1975-1984. doi: 10.1111/add.13505. Epub 2016 Aug 2.

Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population.

Bradley KA1,2,3,4,5, Rubinsky AD6,7,8, Lapham GT6,9, Berger D10,11, Bryson C6,10, Achtmeyer C6,7,10, Hawkins EJ6,7,12, Chavez LJ6, Williams EC6,13, Kivlahan DR6,7,11.

Author information

1
Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA. bradley.k@ghc.org.
2
Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA. bradley.k@ghc.org.
3
Group Health Research Institute, Seattle, WA, USA. bradley.k@ghc.org.
4
Department of Health Services, University of Washington, Seattle, WA, USA. bradley.k@ghc.org.
5
Department of Medicine, University of Washington, Seattle, WA, USA. bradley.k@ghc.org.
6
Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
7
Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
8
The Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA.
9
Group Health Research Institute, Seattle, WA, USA.
10
General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
11
Department of Medicine, University of Washington, Seattle, WA, USA.
12
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
13
Department of Health Services, University of Washington, Seattle, WA, USA.

Abstract

AIMS:

To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2).

DESIGN:

Cohort study.

SETTING:

Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention.

PARTICIPANTS:

A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up').

MEASUREMENTS:

Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low-risk use and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were (1) high-density lipoprotein cholesterol (HDL), (2) alcohol-related gastrointestinal hospitalizations ('GI hospitalizations') and (3) physical trauma, each in the years after baseline and follow-up.

FINDINGS:

Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0-12, mean HDL ranged from 41.4 [95% confidence interval (CI) = 41.3-41.5] to 53.5 (95% CI = 51.4-55.6) mg/l, and probabilities of GI hospitalizations from 0.49% (95% CI = 0.48-0.51%) to 1.8% (95% CI = 1.3-2.3%) and trauma from 3.0% (95% CI = 2.95-3.06%) to 6.0% (95% CI = 5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not (P-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use versus severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (95% CI = 2.54-2.75%) versus 5.15% (95% CI = 3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use (P-values all < 0.05).

CONCLUSIONS:

When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL.

KEYWORDS:

Alcohol drinking; alcohol screening; alcohol-induced disorders; alcohol-related disorders; biomarkers; prevention

PMID:
27349855
DOI:
10.1111/add.13505
[Indexed for MEDLINE]

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