Berger Douglas, Matson Theresa E, Oliver Malia, Jack Helen E, Bobb Jennifer F, Bradley Katharine A, Hallgren Kevin A
General Medicine Service VA Puget Sound, Seattle, Washington, USA.
Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
Alcohol Clin Exp Res (Hoboken). 2025 May;49(5):1106-1116. doi: 10.1111/acer.70038. Epub 2025 Mar 28.
The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a validated, scaled marker of past-year alcohol consumption that is increasingly used in population-based screening and research. Like other screening questionnaires, AUDIT-C scores are influenced by patient and system factors affecting self-report. High-density lipoprotein (HDL) cholesterol increases with alcohol consumption and is routinely measured in primary care. Researchers using AUDIT-C scores as an outcome could potentially use HDL as a population-level check on the performance of alcohol screening, for example, to assess the extent to which changes in AUDIT-C scores after an intervention reflect changes in drinking or changes in self-report. However, the association between AUDIT-C scores and HDL has only been evaluated in limited populations.
Cross-sectional associations between AUDIT-C scores and HDL were examined in 290,091 Kaiser Permanente Washington primary care patients who had HDL measured as part of clinical care in the 365 days before or 14 days after routine screening with the AUDIT-C. Linear regression models examined the association between AUDIT-C scores and HDL and explored effect modification by sociodemographic and clinical characteristics.
AUDIT-C scores were positively associated with HDL, including for subgroups defined by age, sex, race, ethnicity, geographically estimated socioeconomic status, presence of cardiovascular disease, history of alcohol or drug treatment, tobacco use, receipt of lipid-lowering medications, and, for female patients, receipt of oral estrogen or progestin medications. Effect modification analyses showed that most sociodemographic and clinical characteristics modified the association between AUDIT-C and HDL.
The association between AUDIT-C and HDL is present in a range of sociodemographic and clinical subgroups. However, effect modification by sociodemographic and clinical characteristics may limit the use of that association in assessing the validity of alcohol screening scores across heterogeneous populations.
酒精使用障碍识别测试-消费量（AUDIT-C）是一种经过验证的、用于衡量过去一年酒精消费量的量化指标，越来越多地用于基于人群的筛查和研究。与其他筛查问卷一样，AUDIT-C评分会受到影响自我报告的患者和系统因素的影响。高密度脂蛋白（HDL）胆固醇水平会随着酒精摄入量的增加而升高，并且在初级保健中会定期进行检测。使用AUDIT-C评分作为研究结果的研究人员可能会将HDL作为一种群体层面的指标，用于检验酒精筛查的效果，例如，评估干预后AUDIT-C评分的变化在多大程度上反映了饮酒量的变化或自我报告的变化。然而，AUDIT-C评分与HDL之间的关联仅在有限的人群中进行过评估。
对290,091名凯撒医疗集团华盛顿分部的初级保健患者进行了横断面研究，这些患者在使用AUDIT-C进行常规筛查前365天或筛查后14天内接受了HDL检测，检测作为临床护理的一部分。线性回归模型用于检验AUDIT-C评分与HDL之间的关联，并探讨社会人口统计学和临床特征对其的效应修正作用。
AUDIT-C评分与HDL呈正相关，在按年龄、性别、种族、民族、地理区域估算的社会经济地位、心血管疾病的存在情况、酒精或药物治疗史、烟草使用情况、降脂药物的使用情况以及女性患者口服雌激素或孕激素药物的使用情况定义的亚组中也是如此。效应修正分析表明，大多数社会人口统计学和临床特征都会修正AUDIT-C与HDL之间的关联。
AUDIT-C与HDL之间的关联存在于一系列社会人口统计学和临床亚组中。然而，社会人口统计学和临床特征的效应修正作用可能会限制这种关联在评估不同人群中酒精筛查评分有效性方面的应用。
