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Addict Sci Clin Pract. 2012; 7(1): 6.
Published online Apr 30, 2012. doi:  10.1186/1940-0640-7-6
PMCID: PMC3414833
Risk of future trauma based on alcohol screening scores: A two-year prospective cohort study among US veterans
Alex H S Harris,corresponding author1 Anna Lembke,1 Patricia Henderson,1 Shalini Gupta,1 Rudolf Moos,1 and Katharine A Bradley2,3
1Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA
2Group Health Research Institute, and Health Services Research & Development (HSR&D) Northwest Center of Excellence, Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, 1100 Olive Way, 14th Floor, Seattle, WA, 98101, USA
3Departments of Medicine and Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
corresponding authorCorresponding author.
Alex H S Harris: Alexander.Harris2/at/va.gov; Anna Lembke: annalembke/at/stanford.edu; Patricia Henderson: Patricia.Henderson2/at/va.gov; Shalini Gupta: shalini.gupta2/at/va.gov; Rudolf Moos: rmoos/at/stanford.edu; Katharine A Bradley: bradley.k/at/ghc.org
Received August 12, 2011; Accepted April 30, 2012.
Abstract
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.
Keywords: Alcohol, Trauma, Fracture, AUDIT-C, Age, Gender, Screening, Women
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