title: Sex and age differences in the early identification and treatment of alcohol use: a population-based study of patients with alcoholic cirrhosis.
abstract: OBJECTIVE
  To estimate sex differences in health-care utilization among harmful/hazardous drinkers in the period before alcoholic cirrhosis diagnosis, and estimate sex differences in the extent to which alcohol use and brief alcohol interventions were documented for these individuals compared with a control cohort.
  
  
  METHODS
  Retrospective study using linked general practice and hospital admissions data in England.
  
  
  METHODS
  Three hundred and fifty-seven general practitioner (GP) practices in England.
  
  
  METHODS
  A total of 2479 individuals with alcoholic cirrhosis (mean age at diagnosis=56 years), of whom 67% were men; and 24,790 controls without the disease.
  
  
  METHODS
  Rates of primary care visits and hospital admissions prior to the diagnosis of alcoholic cirrhosis for men and women, and the proportion of men and women with alcohol consumption and/or alcohol brief intervention documented in their medical record.
  
  
  RESULTS
  Compared with the general population, patients with alcoholic cirrhosis used primary and secondary health-care services more frequently in the years leading up to their diagnosis. In the years prior to diagnosis, men used primary and secondary health-care services more than did women (P for sex interaction P<0.0001). Men were more likely than women to have their alcohol use recorded [odds ratio (OR) men=1.96, 95% confidence interval (CI)=1.7-2.3; women=1.63, 95% CI=1.4-1.8, P for sex interaction P<0.0017]. By contrast, alcohol interventions were recorded more commonly among women (OR men=4.3, 95% CI=3.7-4.9; women=5.8, 95% CI=4.7-6.9, P for sex interaction=0.07), although less common with increasing age (P for age interaction=0.009).
  
  
  CONCLUSIONS
  In the United Kingdom, prior to alcoholic cirrhosis diagnosis, excess health-care utilization is higher in men than women and men are more likely than women to have their alcohol use recorded. However, women appear to be more likely than men to receive alcohol brief interventions.
authors.affiliation: Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.|UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham City hospital Campus, Clinical Sciences Building, Nottingham, NG5 1PB, UK.
authors.forename: Harmony E
authors.initials: HE
authors.lastname: Otete
authors.affiliation: Division of Primary Care, School of Medicine, University Park,University of Nottingham, Nottingham, NG7 2UH, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Orton
authors.affiliation: Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.
authors.forename: Joe
authors.initials: J
authors.lastname: West
authors.affiliation: Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK.|UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham City hospital Campus, Clinical Sciences Building, Nottingham, NG5 1PB, UK.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Fleming
mesh_terms: D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control*; D016022:Case-Control Studies; D042241:Early Diagnosis; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors
keywords: Alcohol interventions; alcoholic cirrhosis; primary care; secondary care