Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington 98101, USA.
J Rural Health. 2012 Spring;28(2):202-10. doi: 10.1111/j.1748-0361.2011.00389.x. Epub 2011 Aug 24.
United States rural residents tend toward poorer health than urban residents. Although alcohol use is associated with multiple medical conditions and can be reduced via brief primary care-based interventions, it is unknown whether alcohol consumption differs by rurality among primary care patients. We sought to describe alcohol consumption among urban, suburban, and rural Veterans Affairs (VA) outpatients.
Outpatients from 7 VA facilities responded to mailed surveys that included the validated Alcohol Use Disorders Identification Test Consumption (AUDIT-C) screening questionnaire. The ZIP code approximation of the US Department of Agriculture's rural-urban commuting area (RUCA) codes classified participants into urban, suburban, and rural areas. For each area, adjusted logistic regression models estimated the prevalence of past-year abstinence among all participants and unhealthy alcohol use (AUDIT-C ≥ 3 for women and ≥ 4 for men) among drinkers.
Among 33,883 outpatients, 14,967 (44%) reported abstinence. Among 18,916 drinkers, 8,524 (45%) screened positive for unhealthy alcohol use. The adjusted prevalence of abstinence was lowest in urban residents (43%, 95% CI 42%-43%) with significantly higher rates in both suburban and rural residents [45% (44%-46%) and 46% (45%-47%), respectively]. No significant differences were observed in the adjusted prevalence of unhealthy alcohol use among drinkers.
Abstinence is slightly more common among rural and suburban than urban VA outpatients, but unhealthy alcohol use does not vary by rurality. As the VA and other health systems implement evidence-based care for unhealthy alcohol use, more research is needed to identify whether preventive strategies targeted to high-risk areas are needed.
与城市居民相比，美国农村居民的健康状况往往较差。尽管酒精的使用与多种医疗状况有关，并且可以通过基于初级保健的简短干预措施来减少，但尚不清楚初级保健患者的酒精使用是否因农村地区而异。我们旨在描述退伍军人事务部 (VA) 门诊患者的酒精消费情况。
来自 7 个 VA 设施的门诊患者对邮寄的调查问卷做出了回应，该问卷包括经过验证的酒精使用障碍识别测试消耗 (AUDIT-C) 筛查问卷。美国农业部农村-城市通勤区 (RUCA) 代码的邮政编码近似值将参与者分为城市、郊区和农村地区。对于每个地区，调整后的逻辑回归模型估计了所有参与者过去一年的戒酒率以及饮酒者中不健康的酒精使用（女性 AUDIT-C ≥ 3，男性 AUDIT-C ≥ 4）的流行率。
在 33883 名门诊患者中，有 14967 人（44%）报告戒酒。在 18916 名饮酒者中，有 8524 人（45%）筛查出不健康的酒精使用。城市居民的戒酒率最低（43%，95%CI 42%-43%），郊区和农村居民的比率明显更高[分别为 45%（44%-46%）和 46%（45%-47%）]。在饮酒者中，不健康的酒精使用的调整后流行率没有差异。
与城市 VA 门诊患者相比，农村和郊区的戒酒率略高，但农村地区的酒精使用不健康情况并无差异。随着 VA 和其他卫生系统实施基于证据的不健康酒精使用护理，需要进行更多的研究，以确定是否需要针对高风险地区的预防策略。
