title: Alcohol screening scores and all-cause mortality in male Veterans Affairs patients.
abstract: OBJECTIVE
  Extensive research demonstrates a J- or U-shaped association between in-depth interview measures of alcohol consumption and mortality. Little is known about the relationship between alcohol screening questionnaires and mortality. This study examined the association between scores (ranging from 0 to 12) on the three-item Alcohol Use Disorder Identification Test-Consumption Questionnaire (AUDIT-C) and mortality.
  
  
  METHODS
  This cohort study included male outpatients from seven Veterans Affairs (VA) medical centers who completed the AUDIT-C on mailed surveys (1997-2000; n=34,292) and who were followed for a mean of 2.5 years. Death was ascertained from VA databases.
  
  
  RESULTS
  In analyses adjusted for demographics, a U-shaped relationship was observed between AUDIT-C scores and all-cause mortality. Nondrinkers (AUDIT-C 0) and heavy drinkers (AUDIT-C 8-9 and 10-12) had increased risk of death compared with drinkers who screened negative for alcohol misuse (AUDIT-C 1-3): hazard ratios (HR)=1.41 (95% confidence interval [CI]: 1.29-1.54), 1.32 (1.03-1.69), and 1.47 (1.14-1.91), respectively. This association differed across age groups (p=.003). For men younger than 50 years, AUDIT-C scores 10-12 were associated with increased mortality (HR=2.21, 95% CI: 1.29-3.77), whereas for men age 50 or older, self-reported abstinence (AUDIT-C 0) was associated with increased mortality, compared with drinkers with AUDIT-C scores 1-3: HR formen 50-64=1.45 (1.19-1.77); HR for men 65 or older=1.42 (1.28-1.58).
  
  
  CONCLUSIONS
  A U-shaped association between the AUDIT-C and mortality was observed, with important differences by age group. This is the first study to demonstrate that a clinical scaled screening measure of alcohol use has a similar association with mortality to that observed in epidemiological research with lengthier measures.
authors.affiliation: Northwest Center of Excellence for Health Services Research and Development, Department of Veterans Affairs, 1100 Olive Way, Suite 1400, Seattle, Washington 98101, USA.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Kinder
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.forename: Haili
authors.initials: H
authors.lastname: Sun
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000375:Aging; D000428:Alcohol Drinking / Q000401:mortality; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D015577:Geriatric Assessment; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D015337:Multicenter Studies as Topic; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*