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Alcohol Clin Exp Res. 2019 Mar;43(3):465-472. doi: 10.1111/acer.13951. Epub 2019 Feb 3.

Longitudinal Drinking Patterns and Their Clinical Correlates in Million Veteran Program Participants.

Author information

1
University of Louisville School of Nursing , Louisville, Kentucky.
2
Mental Illness Research, Education and Clinical Center , Crescenz VAMC, Philadelphia, Pennsylvania.
3
Department of Psychiatry, Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
4
VA Connecticut Healthcare System , West Haven, Connecticut.
5
School of Medicine , Yale University, New Haven, Connecticut.

Abstract

BACKGROUND:

A variety of measures have been developed to screen for hazardous or harmful drinking. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is one of the screening measures recommended by the U.S. Preventive Services Task Force. Annual administration of the AUDIT-C to all primary care patients is required by the U.S. Veterans Affairs Health System. The availability of data from the repeated administration of this instrument over time in a large patient population provides an opportunity to evaluate the utility of the AUDIT-C for identifying distinct drinking groups.

METHODS:

Using data from the Million Veteran Program cohort, we modeled group-based drinking trajectories using 2,833,189 AUDIT-C scores from 495,178 Veterans across an average 6-year time period. We also calculated patients' age-adjusted mean AUDIT-C scores to compare to the drinking trajectories. Finally, we extracted data on selected clinical diagnoses from the electronic health record and assessed their associations with the drinking trajectories.

RESULTS:

Of the trajectory models, the 4-group model demonstrated the best fit to the data. AUDIT-C trajectories were highly correlated with the age-adjusted mean AUDIT-C scores (rs = 0.94). Those with an alcohol use disorder diagnosis had 10 times the odds of being in the highest trajectory group (consistently hazardous/harmful) compared to the lowest drinking trajectory group (infrequent). Those with hepatitis C, posttraumatic stress disorder, liver cirrhosis, and delirium had 10, 7, 21, and 34%, respectively, higher odds of being classified in the highest drinking trajectory group versus the lowest drinking trajectory group.

CONCLUSIONS:

Trajectories and age-adjusted mean scores are potentially useful approaches to optimize the information provided by the AUDIT-C. In contrast to trajectories, age-adjusted mean AUDIT-C scores also have clinical relevance for real-time identification of individuals for whom an intervention may be warranted.

KEYWORDS:

Alcohol Use Disorder; Electronic Health Record Data; Group-Based Trajectory Modeling; Hazardous Drinking

PMID:
30592535
PMCID:
PMC6691890
[Available on 2020-03-01]
DOI:
10.1111/acer.13951

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