Alcohol Screening Scores and Risk of Hospitalizations for GI Conditions in Men

Authors

  • David H. Au,

    1. Health Services Research & Development, Seattle, Washington
    2. Primary and Specialty Medical Care Service, Seattle, Washington
    3. Department of Medicine, University of Washington, Seattle, Washington
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  • Daniel R. Kivlahan,

    1. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    2. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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  • Chris L. Bryson,

    1. Health Services Research & Development, Seattle, Washington
    2. Primary and Specialty Medical Care Service, Seattle, Washington
    3. Department of Medicine, University of Washington, Seattle, Washington
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  • David Blough,

    1. Department of Pharmacy, University of Washington, Seattle, Washington
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  • Katharine A. Bradley

    1. Health Services Research & Development, Seattle, Washington
    2. Primary and Specialty Medical Care Service, Seattle, Washington
    3. Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington
    4. Department of Medicine, University of Washington, Seattle, Washington
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  • The Veterans Affairs (VA) Ambulatory Care Quality Improvement Project (ACQUIP) was funded by VA HSR&D Grants SDR96-002 and IIR99-376. DHA and CLB are supported by a Department of Veterans Affairs Career Development Award (RCD00-018 and RCD03-177). KAB is currently supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA K23AA00313) and was a Robert Wood Johnson (RWJ) Foundation Generalist Physician Faculty Scholar at the time this research was begun.

  • No claim to original US government works.

Reprint requests: Katharine Bradley, MD, MPH, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101; Fax: 206-764-2935; E-mail: willi@u.washington.edu

Abstract

Background: Alcohol misuse is a common cause of liver disease, upper gastrointestinal (GI) bleeding, and pancreatitis, but it is not known whether alcohol screening questionnaires can identify patients at increased risk for hospitalizations due to these conditions.

Objective: To evaluate the association of alcohol screening scores with the risk of subsequent hospitalization for alcohol-related GI conditions.

Design: Retrospective cohort study.

Participants: Male general medicine outpatients from 7 Veterans Affairs (VA) medical centers who returned mailed questionnaires.

Measurements: The CAGE questionnaire (0–4 points) and the Alcohol Use Disorders Identification Test-Consumption questions (AUDIT-C; 0–12 points) were included on mailed surveys. The main outcome, “GI hospitalization,” was a primary VA or Medicare discharge diagnosis indicating liver disease, upper GI bleeding, or pancreatitis.

Results: Among 31,311 patients followed, a median of 3.75 years, patients with CAGE scores ≥2 points or AUDIT-C scores ≥6 points were at a significantly increased risk for GI hospitalizations. Adjusted hazard ratios (HRadj) ranged from 1.6 (95% CI 1.2–2.0) for CAGE score 2, to 1.7 (1.4–2.2) for CAGE 4, and from 1.4 (1.01–2.0) for AUDIT-C scores from 6 to 7, to 2.7 (1.9–3.8) for AUDIT-C scores from 10 to 12. Secondary analyses demonstrated that the association was the strongest among patients less than 50 years of age who reported drinking in the past year.

Conclusions: Brief alcohol screening questionnaires predict subsequent hospitalizations for alcohol-related GI conditions.

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