Hospitalization and alcohol-related morbidity within three years after screening in middle-aged men

Excessive alcohol consumption and hypertension: clinical implications of current research

Substantial evidence demonstrates that: 1) heavy alcohol consumption (three or more standard drinks per day) is associated with and predictive of hypertension; 2) reduction in alcohol consumption is associated with a significant dose-dependent lowering of mean systolic and diastolic blood pressure; and 3) physician advice can reduce heavy drinking in hypertensive patients. These findings suggest that the routine evaluation of alcohol consumption in hypertensive patients is warranted. The Alcohol Use Disorders Identification Test-C (AUDIT-C), a brief, three-question screening test, is useful in this regard. Alcohol biomarkers can also play a role in detecting and monitoring heavy drinking in hypertensive patients whose self-reports on the AUDIT-C are suspect. Carbohydrate-deficient transferrin, a new alcohol biomarker with high specificity, can provide objective data for feedback and counseling. A routine search for excessive use of alcohol, along with brief interventions and monitoring, can have a major impact on reducing the prevalence of hypertension in the general population.

Biochemical alcohol screening in primary health care

Alcohol biomarkers such as carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) have significant potential for enhancing the quality of medical treatment in primary health care settings. Recent studies demonstrate that these laboratory tests can help the general practitioner in several ways. First, CDT and GGT can detect current heavy drinking in primary care patients with a fair degree of sensitivity (approximately 60% to 70%), with CDT being more specific (approximately 90%). When combined with self-report tests, they can provide a clinically useful alcohol screening battery. Second, elevated CDT and GGT levels have been correlated with specific alcohol-sensitive diseases (e.g., hypertension) and, as such, can serve as risk indicators for those diseases. Third, alcohol biomarkers have proven to be useful in monitoring the effectiveness of brief alcohol interventions with medical patients. Unfortunately, preliminary findings indicate that physicians have little knowledge of current biomarker research as applied to primary health care. Translational studies are needed on methods to facilitate knowledge and use of alcohol biomarkers by general practitioners.

Alcohol use, alcohol disorders, and the use of health services: results from a population survey

Data from a population survey were used to explore relationships among drinking levels/patterns, alcohol dependence or abuse, and the use of emergency services, hospital admissions, and frequent visits to general practitioners in the past year. For both males and females, self-reported hospital admissions were less common among daily moderate drinkers than among lifetime abstainers. Among males, drinkers with no history of alcohol dependence or abuse were less likely to report being in hospital in the last year than lifetime abstainers. For females, some groups defined by drinking patterns/levels and current drinkers without symptoms of alcohol abuse or dependence were more likely to report using emergency services than lifetime abstainers.

Alcohol consumption and disability pension among middle-aged men

PURPOSE

To analyze the relation between alcohol consumption and the risk of disability pension among middle-aged men.

METHODS

In the mid-seventies, complete birth-year cohorts of middle-aged male residents in Malmö, Sweden, were invited to participate in a general health survey. The 3751 men with complete data who constituted the cohort in this study were followed for 11 years. Alcohol consumption was estimated from the scores obtained from a test designed to identify subjects with alcohol related problems.

RESULTS

Of the 498 men granted disability pension during follow-up, 48 stated to be teetotalers. The cumulative incidence of disability pension among teetotalers was 19%, whereas, it was 12% and 16%, respectively, among men with low and high alcohol consumption. The adjusted relative risk (RR) for acquiring a disability pension (using the group with low alcohol consumption as reference) was 1.8 among abstainers and 1.3 among men with high alcohol consumption.

CONCLUSIONS

Alcohol overconsumption, as well as teetotalism, showed a positive relation to disability pension, and a moderate alcohol intake was found to be beneficial with respect to the risk of future disability pension.

"Healthometer"--an instrument for self-distributed health screening and prevention in the population

In the ongoing expansion of medical systems toward prevention and health promotion, primary care is increasingly recognized as a key vehicle and agent. In order to establish a comprehensive health dialogue in the population, there is a need for innovative instruments corresponding to the information and linked media revolution that this shift is a part of. Based upon the experiences of the Department of Preventive Medicine in Malmö, Sweden, a self-mediated, interactive health testing and promotion instrument called "healthometer" has been developed and tested for feasibility. The instrument uses a special variety of a quintile-distributed visual analog scale with the thermometer as reference and allows: (a) easy summation and averaging of single or different aggregates of the test items as a "wellness" profile and score with emphasis upon the positive aspects of health, and (b) recognition against this on the whole favorable background of the weak points motivating further action. The instrument, which can be distributed on paper or electronic medium, supports participation and insight in the initial stages of a directed individual health program for the continuation of which the utilization of professional counsel is stimulated.

Laboratory markers of ethanol intake and abuse: a critical appraisal

Laboratory markers for ethanol intake and abuse and chronic alcoholism currently in use have been critically reviewed. The merits and pitfalls of each test have been evaluated. The clinical use of the new test of carbohydrate-deficient transferrin has been particularly emphasized. Carbohydrate-deficient transferrin currently provides the highest specificity and sensitivity of all commonly used markers of alcoholism.

The commonest rheumatic complaints of over six weeks' duration in a twelve-month period in a defined Swedish population. Prevalences and relationships

In 900 randomly selected individuals, 50-70 years old, we examined the prevalence over the preceding 12-month period of rheumatic complaints of more than 6 weeks' duration. We found them to represent a major health problem, with an overall prevalence of 37.8%, the predominant diagnoses being subacromial shoulder pain (6.7%), neck pain (6.5%), low back pain (6.3%), osteo-arthrosis (8.5%), and arthralgia (4.9%). With a prevalence of 1.0%, primary fibromyalgia was as common as rheumatoid arthritis (0.7%) and other chronic arthritides (1.1%). The prevalences of the different diagnoses were higher among participants whose data were obtained from personal investigation by a physician than among non-participants where data were obtained by interview, letter, and scrutiny of case records. The odds ratio from incurring more than one rheumatic disease was higher for subacromial shoulder pain and lowest for arthralgia and osteo-arthrosis.

Alcoholism among inpatients in a general hospital in Barcelona, Spain

This cross-sectional study in a general hospital revealed that 37.5% of inpatients were alcoholics, excessive drinkers, or probable alcoholics; when only males were considered, that proportion increased to 61.3%. Most of the physical disorders were associated with the amount of alcohol consumed. The age-adjusted mortality rate in the hospital was three times higher in alcoholics than in nonalcoholics. A large number of alcohol problems were not detected by the patients' medical team. An interview about alcohol and drug consumption, the CAGE, the MAST Brief, and the MALT were utilized to diagnose alcoholism; for our population, the former was shown as the most effective instrument.

Middle-aged men before and after disability pension. Health screening profile with special emphasis on alcohol consumption

A total of 5,950 male Malmö residents (from five cohorts, 1926-30) were health screened on two occasions, with an interval of 4-8 years. Disability pensions were granted to 215, of whom 123 were screened both before and after being pensioned. Those 123 constitute the study group reported on here. Among answers to the questionnaire, back and joint pain were the most common complaints mentioned. However, the most striking distinction between the study group and controls was the values of gamma-GT (gamma glutamyltransferase), indicating overconsumption of alcohol in the group of prospective pensioners. Complaints concerning the back were also an outstanding feature of those belonging to the highest deciles of gamma-GT after--but not before--the disability pension had been granted.

Prevalence of excessive or problem drinkers among patients attending somatic outpatient clinics: a study of alcohol related medical care

The prevalence of alcohol related morbidity was studied among 2038 patients attending somatic outpatient clinics. A further 76 patients had refused the study, giving an overall drop out rate of 3.6%. Several methods were combined so as to detect as many patients with problem drinking as possible. According to the criteria and definitions employed 17% of men (confidence interval 15% to 19%) and 4% of women (confidence interval 3% to 5%) were excessive consumers of alcohol or problem drinkers. The highest proportion of such patients--that is, 17%--was noted in the emergency rooms (27% of men, 8% of women). At other clinics the proportions varied from 11% to 17% of men and from 2% to 4% of women. The strongest relations between overconsumption of alcohol and consultation at the clinic were among patients attending the medical outpatient clinic and the emergency rooms; in 86% (confidence interval 75% to 97%) and 88% (confidence interval 81% to 95%) of problem drinkers attending these clinics, respectively, alcohol was related to the consultation. Consultations were related to alcohol in 82% of women with excessive or problem drinking and 73% of men defined in this way. There was a tendency to a higher proportion of men with excessive or problem drinking in the age group 40-49 years. These findings show that among patients classified as excessive or problem drinkers attending somatic outpatient clinics there was a close relation between alcohol consumption and utilisation of medical resources, especially in women.

Methods of intervention to modify drinking patterns in heavy drinkers

More than 30,000 individuals have been investigated in the continuous screening and intervention study in Malmö. Large subsamples of individuals with different levels of serum gamma-glutamyltransferase (GGT) have been characterized and followed up; GGT has proved to be a useful and simple tool in identifying and treating heavy drinkers and monitoring their outcome. In the intervention study, counseling and repeated feedback of GGT results in a group of middle-aged heavy drinkers led to a significant reduction in sick absence, hospitalization, and mortality compared with those in a control group over a period of 6 to 8 years. At follow-up, about 15% of middle-aged men in the general population had serious alcohol problems. Assessment and treatment of heavy drinkers within general medicine would provide a very considerable impact on the total problem of alcohol-related disease.

Orthopedic disorders, morbidity, and sick absenteeism in men with different levels of serum gamma-glutamyltransferase

All orthopedic treatment administered between 1970 and 1982 was analyzed in random subsamples of men 28, 38, and 48 years old being screened for serum gamma-glutamyltransferase (GGT) levels. Of 1,151 screened participants, 631 men had been treated for fracture, distortion, contusion, low-back pain with or without sciatica, or radial epicondylitis. The extent of care and incidence of the different diagnoses over the 13 years, as well as the number of sick days incurred by these men during 1981, were investigated for different GGT brackets. Those men with the highest GGT values (greater than or equal to 1.34 mu kat/liter approximately 80 IU) had 4-6 times more fractures and consulted surgeons 6-13 times more often than those men with the lowest GGT values (less than 0.35 mu kat/liter approximately 20 IU). Epicondylitis and distortion showed the opposite frequency distribution, with the highest incidence occurring in the lowest GGT brackets. Increasing GGT values were also correlated with sick leave days. Men in the highest decile for sick leave had 25 times more fractures than those men with no sick absenteeism. We conclude that an accumulation of alcohol-related orthopedic disorders occurs among men with high GGT values.

Lower limb fractures and registration for alcoholism

During two consecutive years 607 individuals with lower limb fractures were diagnosed. Half of the individuals, 315, were women and only 14 of them had an earlier registration for alcoholism. In the 292 men, however, 73 men or 25%, had been registered at the Department of Alcohol Diseases at least once during the 13 years of observation, the highest registration frequency (30%) was noted in the malleolar fractures in men. In males, 30-50 years of age, there were 37 per cent who had a registration for alcoholism, the highest registration (44%) was noted for fracture of the tibial diaphysis. Males with fracture of the proximal end of the femur between 16-80 years of age were registered for alcoholism in 23%.

Prevention of alcohol-related problems in urban middle-aged males

More than 30,000 individuals have been investigated in the continuous screening and intervention study in Malmö. Large subsamples of individuals with different levels of GGT (gamma-glutamyltransferase) have been characterized. GGT has proven to be a useful and simple tool in tracing, identifying, treating and controlling heavy drinkers. Furthermore, GGT seems to be a new and strong indicator of alcohol-related disabilities and short term mortality in the male population. Individuals with GGT in the tenth deecentile of the GGT distribution have been randomly selected for treatment or control. Results and follow-up for 60 months in the intervention study with randomized controls in middle-aged heavy drinkers indicate a significant reduction in alcohol consumption, sick absence, hospitalization and mortality. Thus, the intervention program seems to be effective in preventing complications of alcoholism on an individual basis.

Alcohol consumption and alcoholism in an urban population in central Sweden

A representative selection of 2,283 individuals, 18-65 years old, in "former" Stockholm County, were examined by psychiatrists in 1970-71. The total of non-participants was 12%. The alcohol consumption pattern and the prevalence of the diagnosis alcoholism for the last 12 months are reported. Significantly more men than women confirmed "very high" and "high" consumption, respectively. The diagnosis alcoholism was given to 4.8% men and 1.4% women. Significantly more women in social class I than in II and III, as significantly more men in social class I than in II stated "very high" or "high" consumption. Social consequences of alcohol consumption, in the form of entries in the Penal Register of the National Board of Excise (Kontrollstyrelsens straffregister) for the years 1965-71, were, on the other hand, found significantly more frequently among men in social class III than in social classes I and II.

Comparison of gamma-glutamyltransferase and questionnaire test as alcohol indicators in different risk groups

gamma-Glutamyltransferase (gamma-GT) and a Malmö modification of the Michigan Alcoholism Screening Test (Mm-MAST) were compared in subsamples of a health screening population of urban middle aged males with characterized levels of alcohol consumption and in the total group of deaths 0-6 years after the screening investigation. The questionnaire was markedly superior to gamma-GT in identifying the alcohol consumption in the known alcoholics but not in the other study groups. gamma-GT may be indicative of alcohol related health disturbances and may be used in their early recognition and as biochemical feedback in their further treatment and control in individuals. It may therefore be of value particularly as an instrument in a programme aimed at prevention of alcohol-related health complications.