title: Alcohol consumption and out-patient services utilization by abstainers and drinkers.
abstract: OBJECTIVE
  Previous studies have found that abstainers utilize out-patient health services more than alcohol consumers. The aim of this study was to investigate this relationship further by including several confounding variables and effect modifiers. It was hypothesized that abstainers utilize more health services because they have less social resources, practice more risky health behaviours, have poorer self-reported health and suffer more from chronic diseases.
  
  
  METHODS
  Cross-sectional health survey of a random sample of adults aged 20-64 in Pomerania, Germany. The response rate was 68.8%. Alcohol consumption was assessed using a quantity-frequency measure and categorized into past-year abstainers, low-risk, medium-risk and high-risk drinkers. Confounders and effect modifiers included socio-demographic and health-related variables.
  
  
  RESULTS
  Abstainers had a 43% higher rate (rate ratio = 1.43, 95% CI = 1.24, 1.63) of physician visits compared to low-risk drinkers, adjusting for age and gender. Medium-risk and high-risk drinkers did not differ from low-risk drinkers in terms of out-patient visits. Further regression adjustment for socio-economic covariates, self-reported health status and chronic diseases suggested that abstainers used more out-patient services because they were more ill than drinkers. The effect of mental health status and the number of chronic diseases on out-patient visits was greater for abstainers than drinkers.
  
  
  CONCLUSIONS
  The relation between alcohol consumption and out-patient services is explained partly by poorer health among the abstainers. Further research is needed to affirm these results, such as transferring this evidence to the utilization of in-patient health services.
authors.affiliation: Medical School, Institute of Epidemiology and Social Medicine, University of Greifswald, Walther-Rathenau-Strasse 48, D-17487 Greifswald, Germany. sebastian.baumeister@uni-greifswald.de
authors.forename: Sebastian E
authors.initials: SE
authors.lastname: Baumeister
authors.forename: Anja
authors.initials: A
authors.lastname: Schumann
authors.forename: Terry T
authors.initials: TT
authors.lastname: Nakazono
authors.forename: Dietrich
authors.initials: D
authors.lastname: Alte
authors.forename: Nele
authors.initials: N
authors.lastname: Friedrich
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D005858:Germany; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013695:Temperance / Q000706:statistics & numerical data*