Associations Between AUDIT-C and Mortality Vary by Age and Sex
Publication: Population Health Management
Volume 13, Issue Number 5
Abstract
We sought to determine the sex- and age-specific risk of mortality associated with scores on the 3-item Alcohol Use Disorder Identification Test–Consumption (AUDIT-C) questionnaire using data from a national sample of Veterans Health Administration (VHA) patients. Men (N = 215,924) and women (N = 9168) who completed the AUDIT-C in a patient survey were followed for 24 months. AUDIT-C categories (0, 1–4, 5–8, 9–12) were evaluated as predictors of mortality in logistic regression models, adjusted for age, race, education, marital status, smoking, depression, and comorbidities. For women, AUDIT-C scores of 9–12 were associated with a significantly increased risk of death compared to the AUDIT-C 1-4 group (odds ratio [OR] 7.09; 95% confidence interval [CI] = 2.67, 18.82). For men overall, AUDIT-C scores of 5–8 and 9–12 were associated with increased risk of death compared to the AUDIT-C 1-4 group (OR 1.13, 95% CI = 1.05, 1.21, and OR 1.63, 95% CI = 1.45, 1.84, respectively) but these associations varied by age. These results provide sex- and age-tailored risk information that clinicians can use in evidence-based conversations with patients about the health-related risks of their alcohol consumption. This study adds to the growing literature establishing the AUDIT-C as a scaled marker of alcohol-related risk or “vital sign” that might facilitate the detection and management of alcohol-related risks and problems. (Population Health Management 2010;13:263–268)
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Di Castelnuovo ACostanzo SBagnardi VDonati MBIacoviello Lde Gaetano G. Alcohol dosing and total mortality in men and women: An updated meta-analysis of 34 prospective studiesArch Intern Med20061662437-2445. 1. Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. Alcohol dosing and total mortality in men and women: An updated meta-analysis of 34 prospective studies. Arch Intern Med 2006;166:2437–2445.
2.
Moore AAGiuli LGould R et al. Alcohol use, comorbidity, and mortalityJ Am Geriatr Soc200654757-762. 2. Moore AA, Giuli L, Gould R, et al. Alcohol use, comorbidity, and mortality. J Am Geriatr Soc 2006;54:757–762.
3.
Klatsky ALArmstrong MAFriedman GD. Alcohol and mortalityAnn Intern Med1992117646-654. 3. Klatsky AL, Armstrong MA, Friedman GD. Alcohol and mortality. Ann Intern Med 1992;117:646–654.
4.
Dawson D. Alcohol consumption, alcohol dependence, and all-cause mortalityAlcohol Clin Exp Res20002472-81. 4. Dawson D. Alcohol consumption, alcohol dependence, and all-cause mortality. Alcohol Clin Exp Res 2000;24:72–81.
5.
Kinder LSBryson CLSun HWilliams ECBradley KA. Alcohol screening scores and all-cause mortality in male Veterans Affairs patientsJ Stud Alcohol Drugs200970253-260. 5. Kinder LS, Bryson CL, Sun H, Williams EC, Bradley KA. Alcohol screening scores and all-cause mortality in male Veterans Affairs patients. J Stud Alcohol Drugs 2009;70:253–260.
6.
Au DHKivlahan DRBryson CLBlough DBradley KA. Alcohol screening scores and risk of hospitalizations for GI conditions in menAlcohol Clin Exp Res200731443-451. 6. 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;31:443–451.
7.
Bradley KAMaynard CKivlahan DRMcDonell MBFihn SD. The relationship between alcohol screening questionnaires and mortality among male veteran outpatientsJ Stud Alcohol200162826-833. 7. Bradley KA, Maynard C, Kivlahan DR, McDonell MB, Fihn SD. The relationship between alcohol screening questionnaires and mortality among male veteran outpatients. J Stud Alcohol 2001;62:826–833.
8.
Harris AHBryson CLSun HBlough DBradley KA. Alcohol screening scores predict risk of subsequent fracturesSubst Use Misuse2009441055-1069. 8. Harris AH, Bryson CL, Sun H, Blough D, Bradley KA. Alcohol screening scores predict risk of subsequent fractures. Subst Use Misuse 2009;44:1055–1069.
9.
Greene CCBradley KABryson CL et al. The association between alcohol consumption and risk of COPD exacerbation in a veteran populationChest2008134761-767. 9. Greene CC, Bradley KA, Bryson CL, et al. The association between alcohol consumption and risk of COPD exacerbation in a veteran population. Chest 2008;134:761–767.
10.
Bryson CLAu DHSun HWilliams ECKivlahan DRBradley KA. Alcohol screening scores and medication nonadherenceAnn Intern Med2008149795-804. 10. Bryson CL, Au DH, Sun H, Williams EC, Kivlahan DR, Bradley KA. Alcohol screening scores and medication nonadherence. Ann Intern Med 2008;149:795–804.
11.
Conigrave KMSaunders JBReznik RB. Predictive capacity of the AUDIT questionnaire for alcohol-related harmAddiction1995901479-1485. 11. Conigrave KM, Saunders JB, Reznik RB. Predictive capacity of the AUDIT questionnaire for alcohol-related harm. Addiction 1995;90:1479–1485.
12.
Batty GDHunt KEmslie CLewars HGale CR. Alcohol problems and all-cause mortality in men and women: Predictive capacity of a clinical screening tool in a 21-year follow-up of a large, UK-wide, general population-based surveyJ Psychosom Res200966317-321. 12. Batty GD, Hunt K, Emslie C, Lewars H, Gale CR. Alcohol problems and all-cause mortality in men and women: Predictive capacity of a clinical screening tool in a 21-year follow-up of a large, UK-wide, general population-based survey. J Psychosom Res 2009;66:317–321.
13.
Moyer AFinney JSwearingen CVergun P. Brief interventions for alcohol problems: A meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populationsAddiction200297279-292. 13. Moyer A, Finney J, Swearingen C, Vergun P. Brief interventions for alcohol problems: A meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction 2002;97:279–292.
14.
Institute of MedicineImproving the Quality of Health Care for Mental and Substance-Use ConditionsWashington, DCNational Academies Press2006. 14. Institute of Medicine. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: National Academies Press; 2006.
15.
Bradley KABush KREpler AJ et al. Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): Validation in a female Veterans Affairs patient populationArch Intern Med2003163821-829. 15. Bradley KA, Bush KR, Epler AJ, 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;163:821–829.
16.
Bush KKivlahan DRMcDonell MBFihn SDBradley 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 TestArch Intern Med19981581789-1795. 16. 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;158:1789–1795.
17.
Rumpf HJHapke UMeyer CJohn U. Screening for alcohol use disorders and at-risk drinking in the general population: Psychometric performance of three questionnairesAlcohol Alcohol200237261-268. 17. 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;37:261–268.
18.
Aertgeerts BBuntinx FAnsoms SFevery J. Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice populationBr J Gen Pract200151206-217. 18. Aertgeerts B, Buntinx F, Ansoms S, Fevery J. Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice population. Br J Gen Pract 2001;51:206–217.
19.
Dawson DAGrant BFStinson FSZhou 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 populationAlcohol Clin Exp Res200529844-854. 19. 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;29:844–854.
20.
Deyo RACherkin DCCiol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJ Clin Epidemiol199245613-619. 20. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.
21.
Arnold NSohn MMaynard CHynes DMVIReC Technical Report 2: VA-NDI Mortality Data Merge ProjectHines, ILVA Information Resource Center2006. 21. Arnold N, Sohn M, Maynard C, Hynes DM. VIReC Technical Report 2: VA-NDI Mortality Data Merge Project. Hines, IL: VA Information Resource Center; 2006.
22.
Klatsky AFriedman GSiegelaub A. Alcohol and mortality: A ten year Kaiser Permanente experienceAnn Intern Med198195139-145. 22. Klatsky A, Friedman G, Siegelaub A. Alcohol and mortality: A ten year Kaiser Permanente experience. Ann Intern Med 1981;95:139–145.
23.
Marmot MShipley MRose GThomas B. Alcohol and mortality: A U-shaped curveLancet19811580-583. 23. Marmot M, Shipley M, Rose G, Thomas B. Alcohol and mortality: A U-shaped curve. Lancet 1981;1:580–583.
24.
Klatsky AArmstrong MFriedman G. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkersAm J Cardiol1990661237-1242. 24. Klatsky A, Armstrong M, Friedman G. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol 1990;66:1237–1242.
25.
Albert CMManson JECook NRAjani UAGaziano JMHennekens CH. Moderate alcohol consumption and the risk of sudden cardiac death among US male physiciansCirculation1999100944-950. 25. Albert CM, Manson JE, Cook NR, Ajani UA, Gaziano JM, Hennekens CH. Moderate alcohol consumption and the risk of sudden cardiac death among US male physicians. Circulation 1999;100:944–950.
26.
Li JMMukamal KJ. An update on alcohol and atherosclerosisCurr Opin Lipidol200415673-680. 26. Li JM, Mukamal KJ. An update on alcohol and atherosclerosis. Curr Opin Lipidol 2004;15:673–680.
27.
McCullough MEHoyt WTLarson DBKoenig HGThoresen C. Religious involvement and mortality: A meta-analytic reviewHealth Psychol200019211-222. 27. McCullough ME, Hoyt WT, Larson DB, Koenig HG, Thoresen C. Religious involvement and mortality: A meta-analytic review. Health Psychol 2000;19:211–222.
28.
Strawbridge WJShema SJCohen RDKaplan GA. Religious attendance increases survival by improving and maintaining good health behaviors mental health and social relationshipsAnn Behav Med20012368-74. 28. Strawbridge WJ, Shema SJ, Cohen RD, Kaplan GA. Religious attendance increases survival by improving and maintaining good health behaviors mental health and social relationships. Ann Behav Med 2001;23:68–74.
29.
Sugarman DEDemartini KSCarey KB. Are women at greater risk? An examination of alcohol-related consequences and genderAm J Addict200918194-197. 29. Sugarman DE, Demartini KS, Carey KB. Are women at greater risk? An examination of alcohol-related consequences and gender. Am J Addict 2009;18:194–197.
30.
Davies BTBowen CK. Total body water and peak alcohol concentration: A comparative study of young, middle-age, and older femalesAlcohol Clin Exp Res199923969-975. 30. Davies BT, Bowen CK. Total body water and peak alcohol concentration: A comparative study of young, middle-age, and older females. Alcohol Clin Exp Res 1999;23:969–975.
31.
Graham KWilsnack RDawson DVogeltanz N. Should alcohol consumption measures be adjusted for gender differences?Addiction1998931137-1147. 31. Graham K, Wilsnack R, Dawson D, Vogeltanz N. Should alcohol consumption measures be adjusted for gender differences? Addiction 1998;93:1137–1147.
32.
Bradley KABadrinath SBush KBoyd–Wickizer JAnawalt B. Medical risks for women who drink alcoholJ Gen Intern Med199813627-639. 32. Bradley KA, Badrinath S, Bush K, Boyd–Wickizer J, Anawalt B. Medical risks for women who drink alcohol. J Gen Intern Med 1998;13:627–639.
33.
Institute of MedicineImproving the Quality of Mental Health Care for Mental and Substance-Use ConditionsWashington DCThe National Academies Press2006. 33. Institute of Medicine. Improving the Quality of Mental Health Care for Mental and Substance-Use Conditions. Washington DC: The National Academies Press; 2006.
Information & Authors
Information
Published In
Population Health Management
Volume 13 • Issue Number 5 • October 2010
Pages: 263 - 268
PubMed: 20879907
Copyright
Copyright 2010, Mary Ann Liebert, Inc.
History
Published in print: October 2010
Published online: 29 September 2010
Topics
Authors
Author Disclosure Statement
Drs. Harris, Bradley, Bowe, and Moos, and Ms. Henderson disclosed no financial conflicts of interest.
This work was made possible through a grant from the National Institute of Alcohol and Alcoholism (R03 AA016793-01) and support from the VA Office of Quality and Performance. The views presented in this paper do not necessarily represent the views of the Department of Veterans Affairs.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Get Access
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.