Objectives: Alcohol use is associated with self-reported health status. However, little is known about the concurrent association between alcohol screening scores and patient perception of health. We evaluated this association in a sample of primarily older male veterans.
Methods: This secondary, cross-sectional analysis included male general medicine outpatients from 7 VA medical centers who returned mailed questionnaires. Screening scores from the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire were divided into 6 categories (0, 1–3, 4–5, 6–7, 8–9, and 10–12). Outcomes included scores on the 8 subscales and 2 component scores of the 36-item Short Form Health Survey (SF-36). Unadjusted and adjusted linear regression models were fit to characterize the association between AUDIT-C categories and SF-36 scores. Models were adjusted for demographic characteristics, smoking, and site—both alone and in combination with 14 self-reported comorbid conditions.
Results: Male respondents (n = 24,531; mean age = 63.6 years) represented 69% of those surveyed with the SF-36. After adjustment, a quadratic (inverted U-shaped) relationship was demonstrated between AUDIT-C categories and all SF-36 scores such that patients with AUDIT-C scores 4–5 or 6–7 reported the highest health status, and patients with AUDIT-C scores 0, 8–9, and ≥10 reported the lowest health status.
Conclusions: Across all measures of health status, patients with the most severe alcohol misuse had significantly poorer health status than those who screened positive for alcohol misuse at mild or moderate levels of severity. The relatively good health status reported by patients with mild-moderate alcohol misuse might interfere with clinicians' acceptance and adoption of guidelines recommending that they counsel these patients about their drinking.
From the Health Services Research and Development (HSR&D) (ECW, VSF, CLB, DRK, KAB), Primary and Specialty Medical Care Service (VSF, CLB, KAB), Center of Excellence in Substance Abuse Treatment and Education (ECW, DRK, KAB), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA; Departments of Medicine (CLB, KAB), Psychiatry and Behavioral Sciences (DRK), Pulmonary and Critical Care (VSF), Health Services (ECW), Pharmacy (DKB), University of Washington, Seattle, WA; Institute of Social and Preventive Medicine (IP-B), University of Lausanne and Centre Hospitalier Vaudois, Lausanne, Switzerland.
Received for publication October 29, 2008; accepted February 18, 2009.
A preliminary version of this study was presented at the Society of General Internal Medicine annual meeting, Chicago, IL, May 14, 2004.
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.
Send correspondence and reprint requests to Emily C. Williams, MPH, VA Puget Sound Health Care System; 1100 Olive Way, Suite 1400; Seattle, WA 98101. E-mail: email@example.com
Supported by VA HSR&D IIR Grant IAC 05-206-1, VA Career Development Awards RCD 02-170-2 (to V.S.F.) and RCD 03-177 (to C.L.B.) and the VA Ambulatory Care Quality Improvement Project (ACQUIP) was funded by VA HSR&D Grants SDR96-002 and IIR99-376.