Association between change in alcohol use reported during routine healthcare screening and change in subsequent hospitalization: A retrospective cohort study

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2025-01-27 DOI:10.1111/add.16771

Helen E. Jack, Douglas B. Berger, Jennifer F. Bobb, Malia M. Oliver, Katherine A. Bradley, Kevin A. Hallgren

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Abstract

Background and aims

Primary care systems often screen for unhealthy alcohol use with brief self-report tools such as the 3-item Alcohol Use Disorders Identification Test for consumption (AUDIT-C). There is little research examining whether change in alcohol use measured on the AUDIT-C captures meaningful change in outcomes affected by alcohol use. This study aimed to measure the association between change in AUDIT-C and change in all-cause hospitalization risk, measured in the year after each AUDIT-C.

Design

Retrospective cohort study.

Setting

Health system in the state of Washington, USA, that conducts annual screening with the AUDIT-C in outpatient care.

Participants

Adults (n = 165 101) who had completed at least two AUDIT-Cs 11–24 months apart (2016–2020).

Measurements

AUDIT-C scores were grouped into five risk categories reflecting no drinking (0), drinking without unhealthy alcohol use [1–2 (female)/1–3 (male)] and unhealthy alcohol use with moderate risk [3–6 (female)/4–6 (male)], high risk (7–8), and very high risk (9–12). Changes in AUDIT-C were based on the number of category levels that changed (0–4). Hospitalizations were binary, reflecting one or more hospitalizations in the 365 days after each AUDIT-C, identified from insurance claims.

Findings

Of 165 101 eligible patients, 5.7% and 6.1% were hospitalized the year after the first and second AUDIT-C, respectively. Decreases in AUDIT-C risk category of 1 or ≥2 levels were associated with statistically significant decreases in risk of hospitalization, compared with the change in hospitalization risk for those with no change in AUDIT-C [1-level decrease: ratio of adjusted risk ratios (aRR) = 0.92, 95% confidence interval (CI) = 0.86–0.99; ≥2-level decrease: ratio of aRR = 0.68, 95% CI = 0.58–0.81]. Increases in AUDIT-C risk category of 1 or ≥2 levels were not associated with statistically significant differences in risk of hospitalization, compared with those with no change in AUDIT-C.

Conclusions

A decrease in AUDIT-C score risk category is associated with a decreased risk of both all-cause hospitalizations and hospitalizations with conditions directly or potentially attributable to alcohol. An increase in AUDIT-C score does not appear to be associated with a change in risk of hospitalization in the following year.

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常规健康检查中报告的酒精使用变化与随后住院的变化之间的关系：一项回顾性队列研究

背景和目的：初级保健系统通常使用简短的自我报告工具筛查不健康的酒精使用，如3项酒精使用障碍识别测试（AUDIT-C）。很少有研究检查AUDIT-C测量的酒精使用变化是否捕获了酒精使用影响的结果的有意义的变化。本研究旨在测量每次审计-c后一年审计-c变化与全因住院风险变化之间的关系。设计：回顾性队列研究。背景：美国华盛顿州的卫生系统，在门诊护理中使用AUDIT-C进行年度筛查。参与者：成人（n = 165 101），间隔11-24个月完成至少两次audit - c（2016-2020）。测量方法：AUDIT-C评分分为5个风险类别，分别是不饮酒（0分）、饮酒但不健康饮酒[1-2（女性）/1-3（男性）]、中度风险不健康饮酒[3-6（女性）/4-6（男性）]、高风险（7-8分）和非常高风险（9-12分）。AUDIT-C中的变化是基于变化的类别级别的数量（0-4）。住院是二元的，反映了从保险索赔中确定的每次审计- c后365天内的一次或多次住院。结果：在165 101例符合条件的患者中，5.7%和6.1%分别在第一次和第二次审计- c后一年住院。与AUDIT-C无变化者相比，AUDIT-C风险类别降低1级或≥2级与住院风险降低有统计学意义相关[1级降低：调整风险比(aRR) = 0.92, 95%可信区间(CI) = 0.86-0.99；≥2个水平下降：比值aRR = 0.68, 95% CI = 0.58-0.81]。与AUDIT-C无变化的患者相比，AUDIT-C风险类别1级或≥2级的增加与住院风险的统计学差异无统计学意义。结论：AUDIT-C评分风险类别的降低与全因住院和直接或潜在归因于酒精的住院风险降低相关。AUDIT-C评分的增加似乎与次年住院风险的变化无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.