Risk of future trauma based on alcohol screening scores: A two-year prospective cohort study among US veterans

Alex H S Harris,Katharine A Bradley,Patricia Henderson,Shalini Gupta,Rudolf Moos,Anna Lembke

doi:10.1186/1940-0640-7-6

Abstract

BackgroundSevere 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.MethodsOutpatients (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.ResultsHaving 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.ConclusionsMen 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.

Highlights

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
The Alcohol Use Disorders Identification Test– Consumption (AUDIT-C) is becoming an increasingly relied upon screening tool for alcohol use problems in modern medical practice [6]
Unlike prior work, which evaluated the risk of fracture and trauma-related hospitalization, this study examines AUDITC scores in relation to two-year risk of any type of trauma across all inpatient, residential, and outpatient settings in a large integrated health-care system

Summary

Introduction

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. The Alcohol Use Disorders Identification Test– Consumption (AUDIT-C) is becoming an increasingly relied upon screening tool for alcohol use problems in modern medical practice [6]. It consists of only three questions, takes less than five minutes to administer, and has been validated across diverse medical settings [7,8,9,10]. The data on AUDIT-C scores and future health risks provide relevant information for evidence-based discussions of alcohol misuse [15], part of a growing movement in primary care settings for improving screening, brief intervention, and referral to treatment (SBIRT) [16]

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