Association between clinical measures of unhealthy alcohol use and subsequent year hospital admissions in a primary care population

Helen E Jack; Malia M Oliver; Douglas B Berger; Jennifer F Bobb; Katharine A Bradley; Kevin A Hallgren

doi:10.1016/j.drugalcdep.2023.109821

Association between clinical measures of unhealthy alcohol use and subsequent year hospital admissions in a primary care population

Drug Alcohol Depend. 2023 Apr 1:245:109821. doi: 10.1016/j.drugalcdep.2023.109821. Epub 2023 Feb 24.

Authors

Helen E Jack¹, Malia M Oliver², Douglas B Berger³, Jennifer F Bobb², Katharine A Bradley⁴, Kevin A Hallgren⁵

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Ave, P.O. Box 359780, Seattle, WA 98104, USA. Electronic address: HJack@UW.edu.
² Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
³ Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Ave, P.O. Box 359780, Seattle, WA 98104, USA; General Medicine Service, Veteran Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA.
⁴ Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9th Ave, P.O. Box 359780, Seattle, WA 98104, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington, 4060 E. Stevens Way NE, Seattle, WA 98195, USA.
⁵ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, P.O. Box 356560, Seattle, WA 98195, USA.

Abstract

Background: Screening for unhealthy alcohol use in primary care may help identify patients at risk for negative health outcomes.

Aims: This study examined the associations between 1) screening with the AUDIT-C (alcohol consumption) and 2) an Alcohol Symptom Checklist (symptoms of alcohol use disorder) and subsequent-year hospitalizations.

Methods: This retrospective cohort study was conducted in 29 primary care clinics in Washington State. Patients were screened in routine care (10/1/2016-2/1/2019) with the AUDIT-C (0-12) and administered the Alcohol Symptom Checklist (0-11) if they had AUDIT-C score ≥ 7. All-cause hospitalizations were measured within 1 year of the AUDIT-C and Alcohol Symptom Checklist. AUDIT-C and Alcohol Symptom Checklist scores were categorized based on previously used cut-points.

Findings: Of 305,376 patients with AUDIT-Cs, 5.3% of patients were hospitalized in the following year. AUDIT-C scores had a J-shaped relationship with hospitalizations, with risk for all-cause hospitalizations higher for patients with the AUDIT-C scores 9-12 (12.1%; 95% CI: 10.6-13.7%, relative to a comparison group of those with AUDIT-C scores 1-2 (female)/1-3 (male) (3.7%; 95% CI: 3.6-3.8%), adjusted for socio-demographics. Patients with AUDIT-C ≥ 7 and Alcohol Symptom Checklist scores reflecting severe AUD were at increased risk of hospitalization (14.6%, 95% CI: 11.9-17.9%) relative to those with lower scores.

Conclusions: Higher AUDIT-C scores were associated with higher incidence of hospitalizations except among people with low-level drinking. Among patients with AUDIT-C ≥ 7, the Alcohol Symptom Checklist identified patients at increased risk of hospitalization. This study helps demonstrate the potential clinical utility of the AUDIT-C and Alcohol Symptom Checklist.

Keywords: AUDIT-C; Acute care settings; Alcohol use; Alcohol use disorder; Healthcare utilization; Hospitalization; Screening.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Alcohol Drinking* / epidemiology
Alcoholism* / diagnosis
Alcoholism* / epidemiology
Alcoholism* / therapy
Female
Hospitalization
Hospitals
Humans
Male
Primary Health Care
Retrospective Studies

Abstract

Publication types

MeSH terms

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