Volk R J, Cantor S B, Steinbauer J R, Cass A R
Department of Family Medicine, The University of Texas Medical Branch at Galveston, 77555-1123, USA.
J Gen Intern Med. 1997 Dec;12(12):763-9. doi: 10.1046/j.1525-1497.1997.07162.x.
To explore potential item bias in the CAGE questions (mnemonic for cut-down, annoyed, guilty, and eye-opener) when used to screen for alcohol use disorders in primary care patients.
Cross-sectional study, conducted in a university-based, family practice clinic, with the presence of an alcohol use disorder determined by structured diagnostic interview using the Alcohol Use Disorder and Associated Disabilities Interview Schedule.
A probability sample of 1,333 adult primary care patients, with oversampling of female and minority (African-American and Mexican-American) patients.
Unadjusted analyses showed marked differences in the sensitivity and specificity of each CAGE question against a lifetime alcohol use disorder, across patient subgroups. Women, Mexican-American patients, and patients with annual incomes above $40,000 were consistently less likely to endorse each CAGE question "yes," after adjusting for the presence of an alcohol use disorder and pattern of alcohol consumption. In results from logistic regression analyses predicting an alcohol use disorder, cut-down was the only question retained in models for each of the subgroups. The guilty question did not contribute to the prediction of an alcohol use disorder; annoyed and eye-opener were inconsistent predictors.
Despite its many advantages, the CAGE questionnaire is an inconsistent indicator of alcohol use disorders when used with male and female primary care patients of varying racial and ethnic backgrounds. Gender and cultural differences in the consequences of drinking and perceptions of problem alcohol use may explain these effects. These biases suggest the CAGE is a poor "rule-out" screening test. Brief and unbiased screens for alcohol use disorders in primary care patients are needed.
探讨CAGE问题（即减少饮酒量、易激惹、有负罪感及眼脸睁开反应的记忆法）用于筛查初级保健患者酒精使用障碍时潜在的条目偏倚。
横断面研究，在一所大学附属的家庭医疗诊所进行，通过使用酒精使用障碍及相关残疾访谈表进行结构化诊断访谈来确定是否存在酒精使用障碍。
1333名成年初级保健患者的概率样本，其中女性及少数族裔（非裔美国人和墨西哥裔美国人）患者进行了过度抽样。
未经调整的分析显示，在各患者亚组中，每个CAGE问题针对终生酒精使用障碍的敏感性和特异性存在显著差异。在调整了酒精使用障碍的存在情况及饮酒模式后，女性、墨西哥裔美国患者以及年收入超过4万美元的患者始终较不可能对每个CAGE问题回答“是”。在预测酒精使用障碍的逻辑回归分析结果中，“减少饮酒量”是每个亚组模型中唯一保留的问题。“有负罪感”问题对酒精使用障碍的预测没有贡献；“易激惹”和“眼脸睁开反应”是不一致的预测因素。
尽管CAGE问卷有诸多优点，但在用于不同种族和族裔背景的初级保健男女患者时，它对酒精使用障碍的指示并不一致。饮酒后果及对问题饮酒的认知方面的性别和文化差异可能解释了这些影响。这些偏倚表明CAGE是一种较差的“排除”筛查测试。需要针对初级保健患者的简短且无偏倚的酒精使用障碍筛查方法。
