Cryer P C, Saunders J, Jenkins L M, Neale H, Cook A C, Peters T J
Centre for Health Services Studies, University of Kent at Canterbury, Kent, UK.
Int J Epidemiol. 2001 Aug;30(4):756-65. doi: 10.1093/ije/30.4.756.
Our previous study found that alcohol abstainers use acute services more and preventative services less than safe level drinkers. The observed relationships between four categories of alcohol consumption and service use were J-shaped for acute services and inverted J-shaped for preventive services. The aim of this paper was to further investigate these relationships.
The design was a health and lifestyle survey of 41 000 randomly-sampled adults in SE England. The response rate was 60%. Distinctive subgroups within the alcohol abstainer group were investigated using cluster analysis, based on socio-demographic and health status variables. Odds ratios for services use for the abstainer clusters, and three alcohol consumption groups were estimated from a logistic regression model which included age, social class, ethnic group, employment status, household composition, whether the respondent was a carer, smoking habit, use of private health insurance, and health status.
Two clusters were formed for both males and females. Cluster 1 comprised, on average, older, frailer, and more disabled people. Cluster 2 comprised younger, healthier people, a greater proportion of whom belonged to ethnic minority groups. Cluster 2 had similar rates of use of Accident & Emergency, GP, optician, and dental services compared with safe level drinkers. Cluster 1's rates differed from those of both Cluster 2 and safe level drinkers in almost all instances.
The J- and inverted J-shaped relationships between alcohol consumption and service use are partly explained by a subgroup of abstainers who are older, of less good health, and who use hospital, clinic, and domiciliary healthcare services much more than safe level drinkers.
我们之前的研究发现，戒酒者比适度饮酒者更多地使用急性服务，而预防性服务的使用则较少。观察到的四类饮酒量与服务使用之间的关系，对于急性服务呈J形，对于预防性服务呈倒J形。本文的目的是进一步研究这些关系。
采用健康与生活方式调查，对英格兰东南部41000名随机抽样的成年人进行调查。回复率为60%。基于社会人口统计学和健康状况变量，采用聚类分析对戒酒者群体中的不同亚组进行了调查。根据包括年龄、社会阶层、种族、就业状况、家庭构成、受访者是否为照顾者、吸烟习惯、私人医疗保险的使用情况以及健康状况在内的逻辑回归模型，估计了戒酒者聚类以及三个饮酒量组的服务使用比值比。
男性和女性均形成了两个聚类。聚类1平均包括年龄较大、身体较虚弱和残疾程度较高的人群。聚类2包括较年轻、较健康的人群，其中较大比例属于少数族裔群体。与适度饮酒者相比，聚类2在事故与急诊、全科医生、验光师和牙科服务的使用比例方面相似。聚类1在几乎所有情况下的使用比例均与聚类2和适度饮酒者不同。
饮酒量与服务使用之间的J形和倒J形关系，部分原因是存在一个戒酒者亚组，他们年龄较大、健康状况较差，并且比适度饮酒者更多地使用医院、诊所和家庭医疗服务。
