Hesselman Susanne, Asp Joline, Pellas Ulrika, Lager Susanne, Wikman Anna
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Center for Clinical Research Dalarna, Falun, Sweden.
Ups J Med Sci. 2024 Nov 22;129. doi: 10.48101/ujms.v129.10770. eCollection 2024.
This study aims to assess the external validity of the Alcohol Use Disorders Identification Test (AUDIT) in Swedish prenatal care as an indicator for alcohol-addiction disorders, and to characterize women with mismatched information in healthcare registers.
This study was designed as a National register-based study.
Sweden.
The study sample included 739,735 pregnancies over the period 2014-2020.
Prospectively collected prenatal AUDIT screening in the was linked to national health databases through individual identification number. The AUDIT score was dichotomized into < 6 points (low-risk use) and ≥ 6 points (hazardous use). Alcohol addiction disorders were defined by a diagnostic code in or drugs dispensed for alcohol dependence in the .
The diagnostic properties of AUDIT were assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy (proportion of true positive and true negative) for an AUDIT score of ≥ 6 points for alcohol disorders. Women with mismatched information in the register were characterized and assessed by multinominal logistic regression, using women with matched information in the registers for reference.
An alcohol-related disorder was recorded in 3.1%, while 25,770 (3.5%) had an AUDIT point ≥ 6. The diagnostic accuracy of the AUDIT ≥ 6 points for detection of an alcohol related disorder during a year prior to pregnancy was 95.7% (95% confidence interval [CI]: 95.7, 95.8), with a positive LR of 8.03 (95% CI: 7.5, 8.6). The sensitivity for detecting a pre-pregnancy alcohol related disorder was 33.0% (95% CI: 30.9, 35.1). Being young, nulliparous, of low education, and of Swedish origin increased the likelihood of being misclassified with the AUDIT. Prior psychiatric care was associated with false negatives, especially for women with neuropsychiatric disorders (odds ratio [OR]: 10.39, 95% CI: 9.89, 10.90).
The accuracy of AUDIT in screening for alcohol disorders at a population-based level was high, but only identified one third of women with alcohol-related disorders when using a cut-off of six points criterion.
本研究旨在评估酒精使用障碍识别测试（AUDIT）在瑞典产前护理中作为酒精成瘾障碍指标的外部效度，并对医疗保健登记中信息不匹配的女性进行特征描述。
本研究设计为一项基于全国登记的研究。
瑞典。
研究样本包括2014 - 2020年期间的739,735例妊娠。
前瞻性收集的产前AUDIT筛查通过个人识别号与国家健康数据库相链接。AUDIT分数被分为<6分（低风险使用）和≥6分（危险使用）。酒精成瘾障碍由诊断代码或用于酒精依赖的药物在数据库中定义。
基于酒精障碍AUDIT分数≥6分的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（LR+）、阴性似然比（LR-）和准确性（真阳性和真阴性比例）评估AUDIT的诊断特性。对登记中信息不匹配的女性进行特征描述，并通过多项逻辑回归进行评估，以登记中信息匹配的女性作为对照。
记录到3.1%的女性患有与酒精相关的疾病，而25,770名（3.5%）女性的AUDIT分数≥6分。AUDIT≥6分在检测妊娠前一年与酒精相关疾病时的诊断准确性为95.7%（95%置信区间[CI]：95.7，95.8），阳性似然比为8.03（95%CI：7.5，8.6）。检测妊娠前与酒精相关疾病的敏感性为33.0%（95%CI：30.9，35.1）。年轻、未生育、低教育水平以及瑞典裔女性被AUDIT误分类的可能性增加。既往接受过精神科护理与假阴性相关，尤其是患有神经精神疾病的女性（优势比[OR]：10.39，95%CI：9.89，10.90）。
AUDIT在基于人群水平筛查酒精障碍方面的准确性较高，但在使用6分标准作为截断值时，仅识别出三分之一患有与酒精相关疾病的女性。
