跨国艾滋病毒队列合作中酒精使用数据与死亡率的协调统一。
Harmonization of alcohol use data and mortality across a multi-national HIV cohort collaboration.
作者信息
Ingle Suzanne M, Trickey Adam, Lankina Anastasia, McGinnis Kathleen A, Justice Amy, Cavassini Matthias, d' Arminio Monforte Antonella, van Sighem Ard, Gill M John, Crane Heidi M, Obel Niels, Jarrin Inma, Wallner Elmar, Guest Jodie, Silverberg Michael J, Vourli Georgia, Wittkop Linda, Sterling Timothy R, Satre Derek D, Burkholder Greer A, Costagliola Dominique, Sterne Jonathan A C
机构信息
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Institute of Immunity and Transplantation, UCL, London, UK.
出版信息
Alcohol Clin Exp Res (Hoboken). 2025 Feb;49(2):407-417. doi: 10.1111/acer.15522. Epub 2025 Jan 8.
BACKGROUND
Alcohol use is measured in diverse ways across settings. Harmonization of measures is necessary to assess effects of alcohol use in multi-cohort collaborations, such as studies of people with HIV (PWH).
METHODS
Data were combined from 14 HIV cohort studies (nine European, five North American) participating in the Antiretroviral Therapy Cohort Collaboration. We analyzed data on adult PWH with measured alcohol use at any time from 6 months before starting antiretroviral therapy. Five cohorts measured alcohol use with AUDIT-C and others used cohort-specific measures. We harmonized alcohol use as grams/day, calculated using country-level definitions of a standard drink. For Alcohol Use Disorders Identification Test (AUDIT-C), we used Items 1 (frequency) and 2 (number of drinks on a typical day). Where alcohol was measured in categories, we used the mid-point to calculate grams/day. We used multivariable Cox models to estimate associations of alcohol use with mortality.
RESULTS
Alcohol use data were available for 83,424 PWH, 22,447 (27%) had AUDIT-C measures and 60,977 (73%) recorded the number of drinks/units per week/day. Of the sample, 19,150 (23%) were female, 54,006 (65%) had White ethnicity, and median age was 42 years. Median alcohol use was 0.3 g/day (interquartile range [IQR] 0-4.8) and 0 g/day (IQR 0-20) for those with and without AUDIT-C. There was a J-shaped relationship between grams/day and mortality, with higher mortality for PWH reporting no alcohol use (adjusted hazard ratio [aHR] 1.46; 95% CI: 1.23-1.72) and heavier (>61.0 g/day) alcohol use (aHR 1.92; 1.41-2.59) compared with 0.1-5.5 g/day among those with AUDIT-C measures. Associations were similar among those with non-AUDIT-C measures.
CONCLUSIONS
Grams/day is a useful metric to harmonize diverse measures of alcohol use. Magnitudes of associations of alcohol use with mortality may differ by setting and measurement method. Higher mortality among those with heavier alcohol use strengthens the case for interventions to reduce drinking.
背景
在不同环境中，酒精使用情况的测量方式多种多样。为了评估酒精使用在多队列合作研究（如艾滋病毒感染者研究）中的影响，有必要统一测量方法。
方法
我们汇总了参与抗逆转录病毒治疗队列合作项目的14项艾滋病毒队列研究（9项来自欧洲，5项来自北美）的数据。我们分析了成年艾滋病毒感染者的数据，这些感染者在开始抗逆转录病毒治疗前6个月的任何时间点都有酒精使用情况的测量记录。5个队列使用酒精使用障碍鉴定测试简表（AUDIT-C）来测量酒精使用情况，其他队列则使用特定队列的测量方法。我们将酒精使用情况统一为以克/天为单位，使用各国对标准饮品的定义来计算。对于酒精使用障碍鉴定测试简表（AUDIT-C），我们使用第1项（饮酒频率）和第2项（典型饮酒日的饮酒量）。当酒精使用情况按类别测量时，我们使用中点值来计算克/天。我们使用多变量Cox模型来估计酒精使用与死亡率之间的关联。
结果
共有83424名艾滋病毒感染者的酒精使用数据可供分析，其中22447人（27%）有AUDIT-C测量数据，60977人（73%）记录了每周/每日的饮酒量/单位。在样本中，19150人（23%）为女性，54006人（65%）为白人，中位年龄为42岁。有AUDIT-C测量数据者的中位酒精使用量为0.3克/天（四分位间距[IQR]为0 - 4.8），无AUDIT-C测量数据者为0克/天（IQR为0 - 20）。克/天与死亡率之间呈J形关系，与有AUDIT-C测量数据且酒精使用量为0.1 - 5.5克/天的人相比，报告不饮酒的艾滋病毒感染者死亡率更高（调整后风险比[aHR]为1.46；95%置信区间：1.23 - 1.72），而重度饮酒者（>61.0克/天）死亡率更高（aHR为1.92；1.41 - 2.59）。在无AUDIT-C测量数据的人群中，关联情况相似。
结论
克/天是统一不同酒精使用测量方法的有用指标。酒精使用与死亡率之间关联的程度可能因环境和测量方法而异。重度饮酒者死亡率更高，这进一步证明了采取干预措施减少饮酒的必要性。
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