Risk of future trauma based on alcohol screening scores: A two-year prospective cohort study among US veterans

Addiction Science & Clinical Practice

Alex H S Harris¹  Anna Lembke¹  Patricia Henderson¹  Shalini Gupta¹  Rudolf Moos¹  Katharine A Bradley² 

[1] Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA

[2] Departments of Medicine and Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

关键词: Women;    Screening;    Gender;    Age;    AUDIT-C;    Fracture;    Trauma;    Alcohol;   

Others  :  789379
DOI  :  10.1186/1940-0640-7-6

 received in 2011-08-12, accepted in 2012-04-30,  发布年份 2012

【 摘 要 】

Background

Severe alcohol misuse as measured by the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) is associated with increased risk of future fractures and trauma-related hospitalizations. This study examined the association between AUDIT-C scores and two-year risk of any type of trauma among US Veterans Health Administration (VHA) patients and assessed whether risk varied by age or gender.

Methods

Outpatients (215, 924 male and 9168 female) who returned mailed AUDIT-C questionnaires were followed for 24 months in the medical record for any International Statistical Classification of Diseases and Related Health Problems (ICD-9) code related to trauma. The two-year prevalence of trauma was examined as a function of AUDIT-C scores, with low-level drinking (AUDIT-C 1–4) as the reference group. Men and women were examined separately, and age-stratified analyses were performed.

Results

Having an AUDIT-C score of 9–12 (indicating severe alcohol misuse) was associated with increased risk for trauma. Mean (SD) ages for men and women were 68.2 (11.5) and 57.2 (15.8), respectively. Age-stratified analyses showed that, for men ≤50 years, those with AUDIT-C scores ≥9 had an increased risk for trauma compared with those with AUDIT-C scores in the 1–4 range (adjusted prevalence, 25.7% versus 20.8%, respectively; OR = 1.24; 95% confidence interval [CI], 1.03–1.50). For men ≥65 years with average comorbidity and education, those with AUDIT-C scores of 5–8 (adjusted prevalence, 7.9% versus 7.4%; OR = 1.16; 95% CI, 1.02–1.31) and 9–12 (adjusted prevalence 11.1% versus 7.4%; OR = 1.68; 95% CI, 1.30–2.17) were at significantly increased risk for trauma compared with men ≥65 years in the reference group. Higher AUDIT-C scores were not associated with increased risk of trauma among women.

Conclusions

Men with severe alcohol misuse (AUDIT-C 9–12) demonstrate an increased risk of trauma. Men ≥65 showed an increased risk for trauma at all levels of alcohol misuse (AUDIT-C 5–8 and 9–12). These findings may be used as part of an evidence-based brief intervention for alcohol use disorders. More research is needed to understand the relationship between AUDIT-C scores and risk of trauma in women.

【 授权许可】

   
2012 Harris et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]US National Center for Injury Prevention and Control: Web-based Injury Statistics Query and Reporting System (WISQARS). [http://www.cdc.gov/injury/wisqars/index.html] webciteCenters for Disease Control and Prevention, ; 2010.
• [2]Degutis LC, Fiellin DA, D'Onofrio G: Traumatic injuries related to alcohol and other drug use. In In Principles of Addiction Medicine. 4th edition. Edited by Ries RK, Fiellin DA, Miller S, Saitz R. Lippincott Williams & Wilkins, Philadelphia, PA; 2009:1091-1098.
• [3]Soderstrom CA, Dischinger PC, Smith GS, McDuff DR, Hebel JR, Gorelick DA: Psychoactive substance dependence among trauma center patients. JAMA 1992, 267(20):2756-2759.
• [4]Klatsky AL, Armstrong MA: Alcohol use, other traits, and risk of unnatural death: a prospective study. Alcohol Clin Exp Res 1993, 17(6):1156-1162.
• [5]Cherpitel CJ, Tam T, Midanik L, Caetano R, Greenfield T: Alcohol and non-fatal injury in the U.S. general population: a risk function analysis. Accident Anal Prev 1995, 27(5):651-661.
• [6]Davoudi M, Rawson RA: Screening, brief intervention, and referral to treatment (SBIRT) initiatives in California: notable trends, challenges, and recommendations. J Psychoactive Drugs 2010, Suppl 6:239-248.
• [7]Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al.: Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med 2003, 163(7):821-829.
• [8]Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA: The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 1998, 158(16):1789-1795.
• [9]Dawson DA, Grant BF, Stinson FS, Zhou Y: Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population. Alcohol Clin Exp Res 2005, 29(5):844-854.
• [10]Rumpf HJ, Hapke U, Meyer C, John U: Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires. Alcohol Alcohol 2002, 37(3):261-268.
• [11]Bryson CL, Au DH, Sun H, Williams EC, Kivlahan DR, Bradley KA: Alcohol screening scores and medication nonadherence. Ann Intern Med 2008, 149(11):795-804.
• [12]Au DH, Kivlahan DR, Bryson CL, Blough D, Bradley KA: Alcohol screening scores and risk of hospitalizations for GI conditions in men. Alcohol Clin Exp Res 2007, 31(3):443-451.
• [13]Lembke A, Bradley KA, Henderson P, Moos R, Harris AH: Alcohol screening scores and the risk of new-onset gastrointestinal illness or related hospitalization. J Gen Intern Med 2011, 26(7):777-782.
• [14]Harris AH, Bradley KA, Bowe T, Henderson P, Moos R: Associations between AUDIT-C and mortality vary by age and sex. Popul Health Manag 2010, 13(5):263-268.
• [15]Saitz R, Horton NJ, Sullivan LM, Moskowitz MA, Samet JH: Addressing alcohol problems in primary care: a cluster randomized, controlled trial of a systems intervention. The screening and intervention in primary care (SIP) study. Ann Intern Med 2003, 138(5):372-382.
• [16]Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J: Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus 2007, 28(3):7-30.
• [17]Harris AH, Bryson CL, Sun H, Blough D, Bradley KA: Alcohol screening scores predict risk of subsequent fractures. Subst Use Misuse 2009, 44(8):1055-1069.
• [18]Williams EC, Bryson CL, Sun H, Chew RB, Chew LD, Blough DK, et al.: Association between Alcohol Screening Results and Hospitalization for Trauma in Veterans Affairs Outpatients. Am J Drug Alcohol Abuse 2012, 38(1):73-80.
• [19]Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, et al.: Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007, 2:CD004148.
• [20]Saitz R, Horton NJ, Sullivan LM, Moskowitz MA, Samet JH: Providing physicians with patient-specific information increases the likelihood of alcohol counseling and decreases patient drinking. J Gen Intern Med 2001, 16(Suppl 1):216.
• [21]Whitlock EP, Polen MR, Green CA, Orleans T, Klein J: Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004, 140(7):557-568.
• [22]Dinh-Zarr T, Diguiseppi C, Heitman E, Roberts I: Preventing injuries through interventions for problem drinking: a systematic review of randomized controlled trials. Alcohol Alcohol 1999, 34(4):609-621.
• [23]Wright SM, Craig T, Campbell S, Schaefer J, Humble C: Patient satisfaction of female and male users of Veterans Health Administration services. J Gen Intern Med 2006, 31(Suppl 3):S26-S32.
• [24]SAS Institute Inc: Statistical Analysis System (SAS®). SAS Institute Inc, Cary, NC; 2008.
• [25]Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR: Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care 2006, 12(10):597-606.
• [26]Holahan CJ, Schutte KK, Brennan PL, Holahan CK, Moos BS, Moos RH: Late-life alcohol consumption and 20-year mortality. Alcohol Clin Exp Res 2010, 34(11):1961-1971.
• [27]US National Institute on Alcohol Abuse and Alcoholism: [http:/ / pubs.niaaa.nih.gov/ publications/ Practitioner/ CliniciansGuide2005/ clinicians_guide.htm] webciteHelping Patients Who Drink Too Much: A Clinician's Guide. National Institutes of Health, Bethesda, MD; 2005. NIH Pub No. 05-3769.
• [28]Wright D: Comparing groups in a before-after design: When t test and ANCOVA produce different results. Br J Educ Psychol 2006, 76(Part 3):663-675.
• [29]Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992, 45(6):613-619.
• [30]Bradley KA, Badrinath S, Bush K, Boyd-Wickizer J, Anawalt B: Medical risks for women who drink alcohol. J Gen Intern Med 1998, 13(9):627-639.
• [31]Brienza RS, Stein MD: Alcohol use disorders in primary care: do gender-specific differences exist? J Gen Intern Med 2002, 17(5):387-397.
• [32]Johnson S, Garzon SR: Alcoholism and women. Am J Drug Alcohol Abuse 1978, 5(1):107-122.
• [33]Kool B, Ameratunga S, Jackson R: The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies. Inj Prev 2009, 15(5):341-347.
• [34]Holbrook T, Barrett-Connor E: A prospective study of alcohol consumption and bone mineral density. BMJ 1993, 306(6891):1506-1509.
• [35]Fillmore KM, Kerr WC, Stockwell T, Chikritzhs T, Bostrom A: Moderate alcohol use and reduced mortality risk: systematic error in prospective studies. Addict Res Theory 2006, 14(2):1-31.
• [36]Kashner TM: Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care 1998, 36(9):1324-1236.
• [37]Bradley KA, Lapham GT, Hawkins EJ, Achtmeyer CE, Williams EC, Thomas RM, et al.: Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med 2011, 26(3):299-306.