Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups

Abstract

Background: The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear.

Objective: To evaluate the validity of the AUDIT-C among primary care patients from the predominant racial/ethnic subgroups within the United States: White, African American, and Hispanic.

Design: Cross-sectional interview validation study.

Participants: 1,292 outpatients from an academic family practice clinic in Texas (90% of randomly sampled eligible).

Measurements and main results: Race/ethnicity was self-reported. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. AUDIT-C sensitivities and specificities at recommended screening thresholds were compared across racial/ethnic groups. AuROCs were greater than 0.85 in all 3 groups, with no significant differences across racial/ethnic groups in men (P = .43) or women (P = .12). At previously recommended cut points, there were statistically significant differences by race in AUDIT-C sensitivities but not specificities. In women, the sensitivity was higher in Hispanic (85%) than in African-American (67%; P = .03) or White (70%; P = .04) women. In men, the sensitivity was higher in White (95%) than in African-American men (76%; P = .01), with no significant difference from Hispanic men (85%; P = .11).

Conclusions: The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there were significant differences in the AUDIT-C's sensitivity but not in specificity across the 3 racial/ethnic groups.

Figure 1

Definitions and terminology. Legend-Figure 1 Risky Drinking: Women: greater than 7 drinks a week or 4 or more drinks on any single occasion; Men: greater than 14 drinks a week or 5 or more drinks on any single occasion. Alcohol Abuse: A maladaptive pattern of alcohol use leading to clinically significant impairment or distress, as manifested by one (or more) of the following occurring within a 12-month period: failure to fulfill major role obligations at work, school, or home; use in hazardous situations; recurrent use despite alcohol-related legal problems or interpersonal problems caused by the effects of alcohol. Alcohol Dependence: Clinically significant impairment or distress resulting from chronic alcohol use in the presence of 3 or more of the following occurring at any time in a 12-month period: tolerance, withdrawal, ingestion of larger amounts or over longer periods than intended, persistent desire or unsuccessful efforts to cut down or control alcohol use, great deal of time spent in activities to obtain, use, or recover from alcohol, important social, occupational, or recreational activities are given up or reduced because of alcohol, continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to be caused or exacerbated by continued drinking. Note: Each section of the figure is a separate subgroup of patients who drink.

Figure 2

Flow diagram of study sample.

Figure 3

AUDIT-C ROC curves for alcohol misuse in men.

Figure 4

AUDIT-C ROC curves for alcohol misuse in women.