ABSTRACT
BACKGROUND
Excessive alcohol use is associated with a variety of negative health outcomes, including liver disease, upper gastrointestinal bleeding, and pancreatitis.
OBJECTIVE
To determine the 2-year risk of gastrointestinal-related hospitalization and new-onset gastrointestinal illness based on alcohol screening scores.
DESIGN
Retrospective cohort study.
PARTICIPANTS
Male (N = 215, 924) and female (N = 9,168) outpatients who returned mailed questionnaires and were followed for 24 months.
MEASUREMENTS
Alcohol Use Disorder Identification Test—Consumption Questionnaire (AUDIT-C), a validated three-item alcohol screening questionnaire (0–12 points).
RESULTS
Two-year risk of hospitalization with a gastrointestinal disorder was increased in men with AUDIT-C scores of 5–8 and 9–12 (OR 1.54, 95% CI = 1.27–1.86; and OR 3.27; 95% CI = 2.62–4.09 respectively), and women with AUDIT-C scores of 9–12 (OR 6.84, 95% CI = 1.85 – 25.37). Men with AUDIT-C scores of 5–8 and 9–12 had increased risk of new-onset liver disease (OR 1.49, 95% CI = 1.30–1.71; and OR 2.82, 95% CI = 2.38–3.34 respectively), and new-onset of upper gastrointestinal bleeding (OR 1.28, 95% CI = 1.05–1.57; and OR 2.14, 95% CI = 1.54-2.97 respectively). Two-year risk of new-onset pancreatitis in men with AUDIT -C scores 9–12 was also increased (OR 2.14; 95% CI = 1.54–2.97).
CONCLUSIONS
Excessive alcohol use as determined by AUDIT-C is associated with 2-year increased risk of gastrointestinal-related hospitalization in men and women and new-onset liver disease, upper gastrointestinal bleeding, and pancreatitis in men. These results provide risk information that clinicians can use in evidence-based conversations with patients about their alcohol consumption.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Schuckit MA. Alcohol-use disorders. Lancet. 2009;373(9662):492–501.
Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos CT. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction. 2003;98(9):1209–28.
Dufour MC, Adamson MD. The epidemiology of alcohol-induced pancreatitis. Pancreas. 2003;27(4):286–90.
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(464):206–17.
Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, Maynard C, Burman ML, Kivlahan DR. 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):821–9.
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):1789–95.
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):844–54.
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):261–8.
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.
Harris AH, Bryson CL, Sun H, Blough D, Bradley KA. Alcohol screening scores predict risk of subsequent fractures. Subst Use Misuse. 2009;44(8):1055–69.
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):443–51.
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):263–8.
Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007;(2):CD004148.
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):557–68.
Bradley KA, Epler AJ, Bush KR, Sporleder JL, Dunn CW, Cochran NE, Braddock CH III, McDonell MB, Fihn SD. Alcohol-related Discussions during General Medicine Appointments of Male VA Patients Who Screen Positive for At-risk Drinking. J Gen Intern Med. 2002;17(5):315–26.
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):S26–32.
Cary NC, SAS, SAS Institute Inc., 2009.
National Institute on Alcohol Abuse and Alcoholism, US Department of Health and Human services, National Institute of Health. Helping Patients Who Drink Too Much: A Clinician’s Guide (updated 2005 guide). Bethesda, US Department of Health and Human Services, US Government Printing Office Health, 2007.
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):613–19.
Klatsky A, Armstrong M, Friedman G. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol. 1990;66(17):1237–42.
Brienza RS, Stein MD. Alcohol use disorders in primary care: do gender-specific differences exist? J Gen Intern Med. 2002;17(5):387–97.
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):627–39.
Johnson S, Garzon SR. Alcoholism and women. Am J Drug Alcohol Abuse. 1978;5(1):107–22.
Kashner T. Agreement between administrative files and written medical records: a case of the Department of Veterans Affairs. Med Care. 1998;36(9):1324–36.
Institute of Medicine. Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: National Academies Press; 2006.
Acknowledgements
This paper does not necessarily represent the views of the Department of Veterans Affairs, Stanford University, or University of Washington. This work was made possible through a grant from NIAAA (R03 AA016793-01) and support from the VA Office of Quality and Performance.
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Appendix A and B
(DOC 112 kb)
Rights and permissions
About this article
Cite this article
Lembke, A., Bradley, K.A., Henderson, P. et al. Alcohol Screening Scores and the Risk of New-Onset Gastrointestinal Illness or Related Hospitalization. J GEN INTERN MED 26, 777–782 (2011). https://doi.org/10.1007/s11606-011-1688-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-011-1688-7