Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India; Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Health Services and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
Addictions Research Group, Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, Bardez, Goa, 403501, India; Harvard University, Cambridge, Massachusetts, Boston, USA.
Drug Alcohol Depend. 2019 Sep 1;202:123-133. doi: 10.1016/j.drugalcdep.2019.04.031. Epub 2019 Jul 16.
The World Health Organization's (WHO) Alcohol Use Disorders Identification Test (AUDIT) is used extensively across the world, with cut-off scores recommended by the WHO. We reviewed the use and validity of AUDIT cut-off scores in low- and middle-income countries as cultural contexts are expected to influence the detection of alcohol use disorders.
The systematic review was guided by an a priori defined protocol consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We searched Cochrane library, Medline, EMBASE, PsycINFO, CINAHL, Indmed, LILACS, and AJOL databases using appropriate search terms. We conducted a narrative synthesis of the data.
We identified 54 distinct studies that used AUDIT cut-off scores which were not in alignment with those recommended by the WHO. India (n = 10), Nigeria (n = 9), and Brazil (n = 9) produced most of these included studies. Most of the studies (n = 42) did not conduct psychometric evaluations of AUDIT cut-off scores. Of the twelve studies which did report psychometric results, a wide range of cut-off scores performed well. In these studies the cut-off scores to detect hazardous drinking ranged from >3 to >5, for harmful drinking from >5 to >16, and for dependent drinking from >7 to >24.
AUDIT is being widely used in LMICs and non-recommended cut-off scores are considered to be appropriate in these countries. It is important to systematically evaluate the psychometric properties of those cut-off scores to ensure the internal validity of the studies in which they are used.
世界卫生组织（WHO）的酒精使用障碍识别测试（AUDIT）在全球范围内广泛使用，WHO 推荐了相应的截断分数。我们回顾了 AUDIT 截断分数在中低收入国家的使用情况和有效性，因为文化背景预计会影响酒精使用障碍的检测。
该系统评价由一个事先确定的方案指导，该方案符合 PRISMA（系统评价和荟萃分析的首选报告项目）声明。我们使用适当的搜索词在 Cochrane 图书馆、Medline、EMBASE、PsycINFO、CINAHL、Indmed、LILACS 和 AJOL 数据库中进行了搜索。我们对数据进行了叙述性综合。
我们确定了 54 项使用 AUDIT 截断分数的不同研究，这些分数与 WHO 推荐的分数不一致。印度（n=10）、尼日利亚（n=9）和巴西（n=9）产生了其中大部分纳入的研究。大多数研究（n=42）没有对 AUDIT 截断分数进行心理测量评估。在报告心理测量结果的十二项研究中，有广泛的截断分数表现良好。在这些研究中，检测危险饮酒的截断分数范围从>3 到>5，有害饮酒的截断分数范围从>5 到>16，依赖饮酒的截断分数范围从>7 到>24。
AUDIT 在 LMIC 中被广泛使用，非推荐的截断分数被认为在这些国家是合适的。系统地评估这些截断分数的心理测量特性非常重要，以确保在使用它们的研究中具有内部有效性。
