Havlik John L, Rhee Taeho Greg, Rosenheck Robert A
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
Am J Drug Alcohol Abuse. 2023 Nov 2;49(6):787-798. doi: 10.1080/00952990.2023.2245125. Epub 2023 Dec 11.
Understanding health-related quality of life (HRQOL) among those who seek treatment for their alcohol use disorder (AUD) and those not seeking AUD treatment is critical to decreasing morbidity and mortality, yet HRQOL in these groups has been little characterized. Characterize HRQOL among those who meet diagnostic criteria for AUD, both receiving and not receiving treatment. This analysis used the NESARC-III database ( = 36,309; female = 56.3%), a nationally representative survey of US adults, to compare four groups: those treated for current AUD; those untreated for current AUD; those with past AUD only; and those who never met criteria for AUD. Multiple regression analysis was used to account for differences in sociodemographic and other behavioral factors across these groups. HRQOL was operationalized using annual quality-adjusted life years (QALYs). Patients treated for past-year AUD had a deficit of 0.07 QALYs/year compared to those who never met criteria for AUD ( < .001). They retained a still clinically meaningful 0.03 QALYs/year deficit after controlling for concomitant psychiatric disorders and other behavioral health factors ( < .001). Those with past-year untreated AUD or past AUD had a near-zero difference in QALYs compared with those who never met criteria for AUD. These findings suggest that previously-reported differences in HRQOL associated with AUD may be due to the problems of the relatively small sub-group who seek treatment. Clinicians seeking to treat those with currently untreated AUD may do better to focus on the latent potential health effects of AUD instead of current HRQOL concerns.
了解酒精使用障碍(AUD)患者及未寻求AUD治疗者的健康相关生活质量(HRQOL)对于降低发病率和死亡率至关重要,但这些群体的HRQOL特征鲜为人知。描述符合AUD诊断标准者(无论是否接受治疗)的HRQOL特征。本分析使用了美国国家酒精与相关疾病流行病学调查(NESARC-III)数据库(n = 36,309;女性占56.3%),这是一项针对美国成年人的具有全国代表性的调查,以比较四组人群:目前接受AUD治疗者;目前未接受AUD治疗者;仅曾患AUD者;以及从未符合AUD标准者。采用多元回归分析来解释这些群体在社会人口学和其他行为因素方面的差异。HRQOL通过年度质量调整生命年(QALY)来衡量。与从未符合AUD标准者相比,过去一年接受AUD治疗的患者每年的QALY损失为0.07(P <.001)。在控制了伴发的精神障碍和其他行为健康因素后,他们每年仍有0.03的QALY损失,这在临床上仍具有意义(P <.001)。与从未符合AUD标准者相比,过去一年未接受AUD治疗者或曾患AUD者的QALY差异接近零。这些发现表明,先前报告的与AUD相关的HRQOL差异可能归因于寻求治疗的相对较小亚组的问题。试图治疗目前未接受治疗的AUD患者的临床医生可能最好关注AUD潜在的健康影响,而不是当前的HRQOL问题。