Cutler S F, Wallace P G, Haines A P
Medical Research Council Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex.
Alcohol Alcohol. 1988;23(6):441-50.
A self-administered questionnaire, the Health Survey Questionnaire (HSQ) was distributed to patients registered with 47 group general practices. The HSQ assesses alcohol consumption using a quantity frequency scale and includes the four CAGE questions and a question on whether respondents think they have an alcohol problem. A random stratified sample of those patients who returned an HSQ (2666 men and 1537 women) were subsequently invited to attend their general practice for an interview with the practice nurse, where weekly alcohol consumption was estimated using both a quantity frequency scale and a systematic enquiry about alcohol consumption for the week immediately preceding the interview. The latter method was taken as the 'gold standard'. Excessive drinkers were defined as men whose weekly consumption by this method was not less than 35 units per week and women drinking at least 21 units per week. After weighing the results to take account of the sampling bias in favour of the excessive drinkers, 11.7% of men and 2.9% of women were excessive drinkers according to the estimate of alcohol consumption at interview. This compares with the 7.6% of men and 2.7% of women who were heavy drinkers by the HSQ quantity frequency scale. The two interview estimates were comparable but in general the HSQ tended to underestimate consumption compared with these estimates. The questionnaire was found to be most effective in screening for excessive drinkers if all the patients who indicated concern about their drinking (i.e. those who were with CAGE positive or had a self-assessed drinking problem), as well as all of those who were above the limits for the trial on the quantity frequency scale, were selected as being potentially excessive drinkers. In the weighted sample, 14.8% of men and 6.9% of women were in this group. Using these selection criteria and taking the interview as the standard for determining the excessive drinkers a sensitivity of 58.6% and specificity of 91.08% was obtained for men, with a positive predictive value of 46.1% and a negative predictive value of 94.3%. For women the test was more sensitive (69.7%) and more specific (95.0%) and had a better negative predictive value (99.1%) than for men. The positive predictive value for women at 29.6% was not as good as that obtained for men. This analysis shows that the HSQ is a fairly effective tool for detecting excessive drinkers in general practices with a small proportion of false positive results. It is both economical and acceptable to patients in a wide range of practice settings.
一份名为健康调查问卷（HSQ）的自填式问卷被分发给在47家团体全科诊所注册的患者。HSQ使用数量频率量表评估饮酒情况，包括四个CAGE问题以及一个关于受访者是否认为自己有饮酒问题的问题。随后，对那些返回HSQ的患者（2666名男性和1537名女性）进行随机分层抽样，邀请他们到全科诊所接受执业护士的访谈，在访谈中，通过数量频率量表以及对访谈前一周饮酒情况的系统询问来估计每周饮酒量。后一种方法被视为“金标准”。过量饮酒者被定义为通过这种方法每周饮酒量不少于35单位的男性以及每周饮酒量至少21单位的女性。在权衡结果以考虑有利于过量饮酒者的抽样偏差后，根据访谈时的饮酒量估计，11.7%的男性和2.9%的女性为过量饮酒者。相比之下，根据HSQ数量频率量表，7.6%的男性和2.7%的女性为重度饮酒者。两种访谈估计结果具有可比性，但总体而言，与这些估计相比，HSQ往往会低估饮酒量。如果将所有表示担心自己饮酒问题的患者（即CAGE问题呈阳性或自我评估有饮酒问题的患者）以及所有在数量频率量表上超过试验限值的患者都选为潜在过量饮酒者，那么发现该问卷在筛查过量饮酒者方面最为有效。在加权样本中，14.8%的男性和6.9%的女性属于这一群体。使用这些选择标准并以访谈作为确定过量饮酒者的标准，男性的敏感度为58.6%，特异度为91.08%，阳性预测值为46.1%，阴性预测值为94.3%。对于女性，该测试更敏感（69.7%）、更特异（95.0%），并且阴性预测值（99.1%）比男性更好。女性的阳性预测值为29.6%，不如男性的阳性预测值。该分析表明，HSQ是在全科诊所中检测过量饮酒者的一种相当有效的工具，假阳性结果比例较小。在广泛的诊所环境中，它既经济又为患者所接受。
