Alcohol Screening Scores and Medical Outcomes: Age and Gender Influences

酒精筛查分数和医疗结果：年龄和性别的影响

基本信息

批准号：
7387264
负责人：
Alex Sox-Harris
金额：
$ 7万
依托单位：
PALO ALTO VETERANS INSTIT FOR RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-04-15 至 2010-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7387264
关键词：
Acute Advisory Committees Age Alcohol consumption Alcohol dependence Alcohols Arrhythmia Behavior Blood Pressure Cardiomyopathies Cardiovascular system Characteristics Clinical Clinical Data Clinical Markers Condition Consumption Counseling Data Databases Dementia Dependence Development Diagnosis Early identification Education Ensure Evaluation Feedback Female Funding Future Gender Goals Guidelines Head and Neck Cancer Health Health Surveys Heavy Drinking Hemorrhage Hospitalization Hypertension Income Injury Institute of Medicine (U.S.)Intervention Laboratory Markers Link Lipids Liver diseases Logistic Regressions Malignant Neoplasms Marital Status Medical Medicare Mental Depression Modeling Monitor Morbidity - disease rate National Institute on Alcohol Abuse and Alcoholism Online Systems Outcome Outpatients Pancreatitis Patient Care Patients Physicians Physiological Population Preventive Primary Care Physician Primary Health Care Provider Purpose Questionnaires Race Rate Research Research Personnel Risk Risk Estimate Risk Factors Risk Marker Sample Size Sampling Score Screening Result Screening procedure Serum Services Severities Smoking Specialist Stroke Surveys Symptoms Testing Time Training and Education Trauma Uncertainty Validation Veterans Woman age group alcohol misuse alcohol use disorder attributable mortality base behavioral health cardiovascular risk factor chronic alcohol ingestion design drinking drinking behavior experience follow-up gastrointestinal gastrointestinal function health administration high risk drinking improved instrument interest male men mortality motivational intervention response sex size

项目摘要

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.

描述（由申请人提供）：尽管有广泛的流行病学证据将酒精消耗和健康联系起来，但很少有研究评估是否可以使用临床实践中使用的经过验证的酒精筛查问卷来评估患者与不良酒精相关的医疗结果的风险水平。酒精使用障碍识别测试（AUDIT-C）是设计和验证供初级保健环境中使用的简短屏幕1-6。对于男性，初步证据将审计-C分数与随后的医学诊断联系起来，这是慢性饮酒的后果（例如肝病，上胃肠道出血和胰腺炎）7和急性酒精使用（例如，创伤性损伤）8，8，8，8，8， 9，以及死亡率10。但是，尚不清楚女性审计-C分数与健康问题之间的关联。此外，研究发现，审计-C分数与医疗结果之间的联系因年龄段11，11的差异很大，但是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; 50-50-64; 50-64; > 65），这些年龄X审计-C相互作用尚未在女性中进行评估。因此，这项R03研究的目的是确定胃肠道（GI）疾病的发作和住院的性别和年龄特异性风险（即肝病，上GI出血，胰腺炎），外伤性损伤的住院以及死亡率使用来自退伍军人卫生管理局（VHA）的全国男性和女性患者样本的审计-C分数归因于审计-C分数。作为VHA对患者健康经历（SHEP）的VHA调查的一部分，审计-C在2004年由全国190,000多名VHA门诊患者的样本完成（对妇女和新返回的退伍军人过度采样；响应率超过71％）。在这项研究中，我们建议将这些审核-C分数与VHA国家患者护理数据库中的临床数据联系起来（2003-2006），Medicare数据（2003-2006）和死亡率数据。我们将估计胃肠道情况下的性别和年龄特定的发病和住院风险，创伤住院以及可归因于审计-C分数的死亡率。逻辑回归将用于建模每个结果的几率。使用MacArthur风险估算模型12，13。我们的长期目标是使用本研究产生的风险信息，将协变量（例如吸烟，抑郁，收入，种族，教育和婚姻状况）添加到未经调整的模型中。通过三种方式：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/动机干预措施； 2）制作基于网络的指南来帮助临床医生解释审计-C分数，并为特定患者提供各种结果的风险估计； 3）寻求资金以进一步验证审核-C以外的目的，目的是评估其作为滥用酒精滥用生命的潜力。拟议的研究将校准审计-C，以便临床医生和临床研究人员可以将其用作生命体征或与酒精相关的发病率和死亡率的风险标记，并促进和激励整个酒精的管理滥用，从高于建议的限制到依赖。性别和年龄范围的风险信息可以说服临床医生，患者的酒精滥用是与医学相关的，并提供了与患者有关其饮酒与健康相关风险的对话的证据。