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Association Between Alcohol Screening Scores and Mortality in Black, Hispanic, and White Male Veterans

Authors

  • Emily C. Williams,

    Corresponding author
    1. Department of Health Services, University of Washington, Seattle, Washington
    • Northwest Center of Excellence for Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
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  • Katharine A. Bradley,

    1. Group Health Research Institute, Seattle, Washington
    2. Northwest Center of Excellence for HSR&D, VA Puget Sound Health Care System, Seattle, Washington
    3. Departments of Health Services and Medicine, University of Washington, Seattle, Washington
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  • Shalini Gupta,

    1. Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California
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  • Alex H. S. Harris

    1. Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California
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  • Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Washington.

Reprint requests: Emily C. Williams, PhD, MPH, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101; Tel.: 206-277-6133; Fax: 206-764-2935; E-mail: williams3@va.gov

Abstract

Background

Scores on the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire are associated with mortality, but whether or how associations vary across race/ethnicity is unknown.

Methods

Self-reported black (n = 13,068), Hispanic (n = 9,466), and white (n = 182,688) male Veterans Affairs (VA) outpatients completed the AUDIT-C via mailed survey. Logistic regression models evaluated whether race/ethnicity modified the association between AUDIT-C scores (0, 1 to 4, 5 to 8, and 9 to 12) and mortality after 24 months, adjusting for demographics, smoking, and comorbidity.

Results

Adjusted mortality rates were 0.036, 0.033, and 0.054, for black, Hispanic, and white patients with AUDIT-C scores of 1 to 4, respectively. Race/ethnicity modified the association between AUDIT-C scores and mortality (p = 0.0022). Hispanic and white patients with scores of 0, 5 to 8, and 9 to 12 had significantly increased risk of death compared to those with scores of 1 to 4; Hispanic ORs: 1.93, 95% CI 1.50 to 2.49; 1.57, 1.07 to 2.30; 1.82, 1.04 to 3.17, respectively; white ORs: 1.34, 95% CI 1.29 to 1.40; 1.12, 1.03 to 1.21; 1.81, 1.59 to 2.07, respectively. Black patients with scores of 0 and 5 to 8 had increased risk relative to scores of 1 to 4 (ORs 1.28, 1.06 to 1.56 and 1.50, 1.13 to 1.99), but there was no significant increased risk for scores of 9 to 12 (ORs 1.27, 0.77 to 2.09). Post hoc exploratory analyses suggested an interaction between smoking and AUDIT-C scores might account for some of the observed differences across race/ethnicity.

Conclusions

Among male VA outpatients, associations between alcohol screening scores and mortality varied significantly depending on race/ethnicity. Findings could be integrated into systems with automated risk calculators to provide demographically tailored feedback regarding medical consequences of drinking.

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