VA Health Services Research & Development, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington.
University of Washington School of Public Health, Department of Health Services, Seattle, Washington.
J Rural Health. 2019 Jun;35(3):330-340. doi: 10.1111/jrh.12326. Epub 2018 Oct 19.
For people living with HIV (PLWH), alcohol use is harmful and may be influenced by unique challenges faced by PLWH living in rural areas. We describe patterns of alcohol use across rurality among PLWH.
Veterans Aging Cohort Study electronic health record data were used to identify patients with HIV (ICD-9 codes for HIV or AIDS) who completed AUDIT-C alcohol screening between February 1, 2008, and September 30, 2014. Regression models estimated and compared 4 alcohol use outcomes (any use [AUDIT-C > 0] and alcohol use disorder [AUD; ICD-9 codes for abuse or dependence] diagnoses among all PLWH, and AUDIT-C risk categories: lower- [1-3 men/1-2 women], moderate- [4-5 men/3-5 women], higher- 6-7]), and severe-risk [8-12], and heavy episodic drinking (HED; ≥1 past-year occasion) among PLWH reporting use) across rurality (urban, large rural, small rural) and census-defined region.
Among 32,699 PLWH (29,540 urban, 1,301 large rural, and 1,828 small rural), both any alcohol use and AUD were highest in urban areas, although this varied across region. Predicted prevalence of any alcohol use was 54.1% (53.5%-54.7%) in urban, 49.6% (46.9%-52.3%) in large rural, and 50.6% (48.3%-52.9%) in small rural areas (P < .01). Predicted prevalence of AUD was 14.4% (14.0%-14.8%) in urban, 11.8% (10.0%-13.5%) in large rural, and 12.3% (10.8%-13.8%) in small rural areas (P < .01). Approximately 12% and 25% had higher- or severe-risk drinking and HED, respectively, but neither differed across rurality.
Though some variation across rurality and region was observed, alcohol-related interventions are needed for PLWH across all geographic locations.
对于感染艾滋病毒的人（PLWH）来说，饮酒是有害的，并且可能受到 PLWH 生活在农村地区所面临的独特挑战的影响。我们描述了 PLWH 中农村地区饮酒模式的差异。
使用退伍军人老龄化队列研究电子健康记录数据，确定在 2008 年 2 月 1 日至 2014 年 9 月 30 日期间完成 AUDIT-C 酒精筛查的 HIV 患者（HIV 的 ICD-9 代码或艾滋病）。回归模型估计并比较了所有 PLWH 的 4 种饮酒结果（AUDIT-C > 0 的任何使用和酒精使用障碍[AUD；ICD-9 代码为滥用或依赖]诊断），以及 AUDIT-C 风险类别（低风险[1-3 男性/1-2 女性]，中度风险[4-5 男性/3-5 女性]，高风险[6-7]）和严重风险[8-12]，以及报告使用的 PLWH 中的重度间歇性饮酒（HED；≥1 次过去一年的场合）在农村地区（城市、大农村、小农村）和人口普查定义的地区之间。
在 32699 名 PLWH 中（29540 名城市，1301 名大农村，1828 名小农村），城市地区的任何酒精使用和 AUD 均最高，尽管在不同地区有所不同。城市地区的任何酒精使用的预测患病率为 54.1%（53.5%-54.7%），大农村地区为 49.6%（46.9%-52.3%），小农村地区为 50.6%（48.3%-52.9%）（P <.01）。城市地区 AUD 的预测患病率为 14.4%（14.0%-14.8%），大农村地区为 11.8%（10.0%-13.5%），小农村地区为 12.3%（10.8%-13.8%）（P <.01）。大约 12%和 25%的人有更高风险或严重风险的饮酒和 HED，但在农村地区没有差异。
尽管观察到一些地区和地区之间的差异，但需要在所有地理区域为 PLWH 提供与酒精相关的干预措施。
