Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA.
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.
Alcohol Clin Exp Res. 2022 Sep;46(9):1742-1752. doi: 10.1111/acer.14915. Epub 2022 Aug 11.
Both human immunodeficiency virus (HIV) infection and alcohol use predispose to autonomic/sensory neuropathy, imbalance symptoms, and cognitive impairment-conditions associated with a greater risk of falls-yet it is unclear how to identify people with HIV (PWH) whose drinking is associated with falls. Research on alcohol and falls using the same instruments in different countries could help to specify the level of alcohol use associated with fall risk. We examined whether a consumption-based measure (the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and/or a symptom-based measure (DSM-5 criteria for alcohol use disorder [AUD]) are associated with sustaining a fall among PWH in St Petersburg, Russia and Boston, Massachusetts in the United States.
Separate multivariate logistic regressions were used for each cohort to examine cross-sectional associations for each alcohol measure predicting fall. Potential confounders included physical functioning, depressive symptoms, and other substance use (measured with the Addiction Severity Index).
A fall was reported by 35% (87/251) of the sample in Boston and 12% (46/400) in St Petersburg. Each additional AUD criterion-but not higher AUDIT-C score-was significantly associated with a fall in both Boston (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.02, 1.18) and St Petersburg (adjusted OR AOR = 1.10; 95% CI 1.02, 1.18). Heavy alcohol use (>6 drinks/occasion, any vs. none) was associated with more than twice the odds of a fall (AOR = 2.24; 95% CI 1.21, 4.13) in Boston.
These findings suggest that while fall risk may vary by setting and population, heavy alcohol use and AUD symptom severity are potential targets for interventions to prevent falls. Studies in diverse global settings advance our understanding of the relationship between alcohol and falls in PWH.
人类免疫缺陷病毒 (HIV) 感染和饮酒都会导致自主神经/感觉神经病变、平衡失调症状和认知障碍，这些情况与跌倒风险增加有关，但目前尚不清楚如何识别与饮酒有关的 HIV 感染者 (PWH) 发生跌倒的风险。在不同国家使用相同的工具进行酒精和跌倒研究可以帮助明确与跌倒风险相关的饮酒水平。我们研究了在俄罗斯圣彼得堡和美国马萨诸塞州波士顿的 PWH 中，基于饮酒量的测量方法（酒精使用障碍识别测试-饮酒量 [AUDIT-C]）和/或基于症状的测量方法（酒精使用障碍诊断与统计手册第五版 [AUD]）是否与跌倒有关。
我们分别使用多变量逻辑回归来检验每个队列中每个酒精测量指标与跌倒的横断面关联。潜在的混杂因素包括身体功能、抑郁症状和其他物质使用（使用成瘾严重程度指数测量）。
波士顿的样本中有 35%（87/251）报告了跌倒，而圣彼得堡的样本中有 12%（46/400）报告了跌倒。在波士顿和圣彼得堡，每个附加的 AUD 标准而不是更高的 AUDIT-C 评分与跌倒显著相关（比值比 [OR]分别为 1.10；95%置信区间 [CI] 1.02，1.18 和调整后的 OR AOR 分别为 1.10；95% CI 1.02，1.18）。与从不饮酒相比，在波士顿，大量饮酒（>6 杯/次，任何 vs. 无）与跌倒的几率增加了两倍多（OR 分别为 2.24；95% CI 1.21，4.13）。
这些发现表明，虽然跌倒风险可能因环境和人群而异，但大量饮酒和 AUD 症状严重程度可能是预防跌倒的干预目标。在不同的全球环境中开展研究可以增进我们对 HIV 感染者中酒精与跌倒关系的理解。
