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Mi J, Ishida M, Anindya K, McPake B, Fitzgibbon B, Laverty AA, Tran-Duy A, Lee JT. Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis. Front Public Health 2023; 11:1077793. [PMID: 38089024 PMCID: PMC10711273 DOI: 10.3389/fpubh.2023.1077793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Background Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia. Methods We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status. Results After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66-2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21-1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45-0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97-2.29, p < 0.001) after adjusting for all other health risk factors and covariates. Conclusion Our study contributed to the growing body of literature on the relative impact of health risk factors for healthcare resource utilization, work-related outcomes and HRQoL. Our results suggested that public health interventions aim at improving these risk factors, particularly physical inactivity and obesity, can offer substantial benefits, not only for healthcare resource utilization but also for productivity.
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Affiliation(s)
- Jun Mi
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kanya Anindya
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bernadette Fitzgibbon
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony A. Laverty
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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Havlik JL, Rhee TG, Rosenheck RA. Characterization of quality of life among individuals with current treated, untreated, and past alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:787-798. [PMID: 37788415 DOI: 10.1080/00952990.2023.2245125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/28/2023] [Indexed: 10/05/2023]
Abstract
Background: Understanding health-related quality of life (HRQOL) among those who seek treatment for their alcohol use disorder (AUD) and those not seeking AUD treatment is critical to decreasing morbidity and mortality, yet HRQOL in these groups has been little characterized.Objectives: Characterize HRQOL among those who meet diagnostic criteria for AUD, both receiving and not receiving treatment.Methods: This analysis used the NESARC-III database (n = 36,309; female = 56.3%), a nationally representative survey of US adults, to compare four groups: those treated for current AUD; those untreated for current AUD; those with past AUD only; and those who never met criteria for AUD. Multiple regression analysis was used to account for differences in sociodemographic and other behavioral factors across these groups. HRQOL was operationalized using annual quality-adjusted life years (QALYs).Results: Patients treated for past-year AUD had a deficit of 0.07 QALYs/year compared to those who never met criteria for AUD (P < .001). They retained a still clinically meaningful 0.03 QALYs/year deficit after controlling for concomitant psychiatric disorders and other behavioral health factors (P < .001). Those with past-year untreated AUD or past AUD had a near-zero difference in QALYs compared with those who never met criteria for AUD.Conclusion: These findings suggest that previously-reported differences in HRQOL associated with AUD may be due to the problems of the relatively small sub-group who seek treatment. Clinicians seeking to treat those with currently untreated AUD may do better to focus on the latent potential health effects of AUD instead of current HRQOL concerns.
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Affiliation(s)
- John L Havlik
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
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Barbosa C, Dowd WN, Karriker-Jaffe KJ, Zarkin G. Modeling the impact of a long-term horizon and multiple treatment episodes on estimates of the cost-effectiveness of alcohol treatment in the United States. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2121-2137. [PMID: 38226759 PMCID: PMC10792252 DOI: 10.1111/acer.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Most clinical studies of alcohol use disorder (AUD) treatment have short follow-up periods, underestimating the full benefits of alcohol treatment. Furthermore, clinical studies only consider one treatment cycle and do not account for the need for multiple episodes to treat a chronic recurrent condition. METHODS A validated microsimulation model of the long-term drinking patterns of people with AUD in the United States simulated 10,000 individuals resembling those from a large clinical trial. The model was used to assess the impact of (1) 1-year, 5-year, and lifetime horizon on alcohol treatment cost-effectiveness estimates and (2) no, one, two, four, and unlimited additional treatment episodes on alcohol treatment cost-effectiveness estimates. Model outcomes included healthcare costs, crime costs, labor market productivity, life expectancy, quality-adjusted life years (QALYs), alcohol-related hospitalizations, and deaths. Cost-effectiveness analyses were conducted for two perspectives: a healthcare perspective that included costs from hospitalization and AUD treatment, and a broader societal perspective that also included crime costs and productivity. RESULTS The incremental cost per additional QALY gained for alcohol treatment compared with no treatment decreased from $55,590 after 1 year to $78 when healthcare costs and QALYs were tracked over the lifetime, that is, treatment became more cost effective. Treatment was cost saving for any time frame when the impacts on crime and labor productivity were also accounted for in a societal perspective. Access to multiple treatment episodes dominated (i.e., it was more effective and less costly) than no-treatment and one-episode scenarios. From a healthcare perspective, incremental costs per additional QALY for increasing from a maximum of two to four treatment episodes was $499 and from four to unlimited episodes was $5049. The unlimited treatment scenario dominated all others from a societal perspective. Results were robust in sensitivity analyses. CONCLUSIONS A long-term perspective and multiple episodes of alcohol treatment improve cost-effectiveness estimates. When societal impacts are included, alcohol treatment is cost saving. Results support the value of alcohol treatment.
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Affiliation(s)
| | - William N Dowd
- RTI International, Research Triangle Park, NC, United
States
| | | | - Gary Zarkin
- RTI International, Research Triangle Park, NC, United
States
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Wittenberg E, Labutte C, Thornburg B, Gebreselassie A, Barbosa C, Bray JW. Alcohol consumption and health-related quality of life in the US during the COVID-19 pandemic: a US national survey. J Patient Rep Outcomes 2022; 6:106. [PMID: 36217061 PMCID: PMC9550307 DOI: 10.1186/s41687-022-00516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Alcohol consumption has changed during the COVID-19 pandemic yet the impacts on alcohol-related outcomes, and specifically health-related quality of life, are not completely known. Our objective was to assess the association between alcohol consumption and health-related quality of life (HRQOL) during the COVID-19 pandemic. METHOD We conducted an on-line/telephone survey of three cross-sectional samples of US adults during a nine-month stretch of the pandemic, from August 2020 through April 2021, collecting data on drinking-current quantity/frequency and change since prior to pandemic, HRQOL (using the SF-6D), and perceived impact of the pandemic on respondents' lives-overall impact and disruptions across various dimensions (job loss, school closures, social isolation, loss of income). We pooled the data from the three administrations and applied survey weights to reflect the US population. We described drinking behavior and pandemic impact, and regressed HRQOL on alcohol consumption risk level (per World Health Organization categories), change in drinking since pre-pandemic, and pandemic impact using weighted least squares, controlling for respondents' demographic characteristics. We tested the significance of categorical variables using Wald tests at a p-value of 0.05. RESULTS Among 3,125 respondents, weighted to reflect the US population, 68% reported drinking during the pandemic and 40% reported a change in drinking from pre-pandemic level (either increased or decreased). Mean HRQOL among our sample was 0.721 (SD 0.003). Any change in drinking from pre-pandemic level was independently associated with significantly lower HRQOL compared to never drinking (pre or during pandemic), from - 0.0251 points for decreased/stopped drinking to -0.0406 points for increased drinking (combined levels' Wald test F = 10.62, p < 0.0000). COVID-19 pandemic related impacts/disruptions were associated with HRQOL decrements ranging from - 0.0834 to -0.1340 (Wald test F = 64.34, p < 0.0000). CONCLUSION The US population HRQOL was substantially lower during the pandemic than reported a decade earlier (mean = 0.79 in 2012-13). While pandemic-related impacts and disruptions may explain a large part of this decrement, changes in drinking-and the associated implications of such changes-might also play a role. Both individuals who reduced their drinking during the pandemic and those who increased consumption may be at risk of poor HRQOL.
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Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard TH Chan School of Public Health, 718 Huntington Avenue, 02115, Boston, MA, USA.
| | - Collin Labutte
- grid.266860.c0000 0001 0671 255XBryan School of Business and Economics, University of North Carolina, 462-D Bryan Building, PO Box 26710, 27402-6170 Greensboro, NC USA
| | - Benjamin Thornburg
- grid.21107.350000 0001 2171 9311John Hopkins Bloomberg School of Public Health, Hampton House, 4th floor, 624 N Broadway, 21205 Baltimore, MD USA
| | - Abraham Gebreselassie
- grid.266860.c0000 0001 0671 255XBryan School of Business and Economics, University of North Carolina, 462-D Bryan Building, PO Box 26710, 27402-6170 Greensboro, NC USA
| | - Carolina Barbosa
- grid.62562.350000000100301493RTI International, 230 West Monroe Street, Suite 2100, 60606 Chicago, IL USA
| | - Jeremy W. Bray
- grid.266860.c0000 0001 0671 255XBryan School of Business and Economics, University of North Carolina, 462-D Bryan Building, PO Box 26710, 27402-6170 Greensboro, NC USA
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Thornburg B, Bray JW, Wittenberg E. Health Utility of Drinkers' Family Members: A Secondary Analysis of a US Population Data Set. MDM Policy Pract 2022; 7:23814683221128507. [PMID: 36187422 PMCID: PMC9520150 DOI: 10.1177/23814683221128507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background. Problematic alcohol use is known to harm individuals surrounding the drinker. This study described the health utility of people who reported having a family member(s) whom they perceived as a "problem drinker."Methods. We conducted a secondary analysis of the US National Epidemiologic Survey of Alcohol and Related Conditions Wave 3 (NESARC-III, 2012-13) data to estimate the independent associations of a family member's problem drinking on the respondent's health utility, also known as health-related quality of life, assessed via the SF-6D. Participants included 29,159 noninstitutionalized adults, of whom 21,808 reported perceiving a family member or members as having a drinking problem at any point in that person's life. Respondent drinking was assessed via self-report and diagnostic interview. We used population-weighted multivariate regression to estimate disutility. Results. After adjusting for the respondent's own alcohol consumption, alcohol use disorder (AUD), family structure, and sociodemographic characteristics, the mean decrement in SF-6D score associated with perceiving a family member as a problem drinker ranged from 0.033 (P < 0.001) for a spouse/partner to 0.023 (P < 0.001) for a grandparent, sibling, aunt, or uncle. The mean decrement in SF-6D score from having AUD oneself was 0.039 (P < 0.001). Conclusions. Perceived problem drinking within one's family is associated with statistically significant losses in health utility, the magnitude of which is dependent on relationship type. The adverse consequences associated with problem drinking in the family may rival having AUD oneself. Implications. Family-oriented approaches to AUD interventions may confer outsize benefits, especially if focused on the spouse or partner. Economic evaluation of alcohol misuse could be made more accurate through the inclusion of family spillover effects. Highlights Spillover effects from problem drinking in the family vary by relationship type.One's perception of their spouse or child as having a drinking problem is associated with a utility decrement of equal magnitude to having alcohol use disorder oneself.Medical decision makers should consider the outsize effects of family spillovers in treatment decisions in the context of alcohol consumption, particularly among spouses and children of problem drinkers.Economic evaluation should consider how to incorporate family spillover effects from problem drinking in alcohol-related models.
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Affiliation(s)
- Benjamin Thornburg
- Benjamin Thornburg, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205-2103, USA; ()
| | - Jeremy W. Bray
- Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Eve Wittenberg
- Harvard TH Chan School of Public Health, Boston, MA, USA
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Barbosa C, Dowd WN, Neuwahl SJ, Rehm J, Imtiaz S, Zarkin GA. Modeling the impact of COVID-19 pandemic-driven increases in alcohol consumption on health outcomes and hospitalization costs in the United States. Addiction 2022; 118:48-60. [PMID: 35915549 PMCID: PMC9539393 DOI: 10.1111/add.16018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol consumption increased in the early phases of the COVID-19 pandemic in the United States. Alcohol use disorder (AUD) and risky drinking are linked to harmful health effects. This paper aimed to project future health and cost impacts of shifts in alcohol consumption during the COVID-19 pandemic. DESIGN An individual-level simulation model of the long-term drinking patterns for people with life-time AUD was used to simulate 10 000 individuals and project model outcomes to the estimated 25.9 million current drinkers with life-time AUD in the United States. The model considered three scenarios: (1) no change (counterfactual for comparison); (2) increased drinking levels persist for 1 year ('increase-1') and (3) increased drinking levels persist for 5 years ('increase-5'). SETTING United States. PARTICIPANTS Current drinkers with life-time AUD. MEASUREMENTS Life expectancy [life-years (LYs)], quality-adjusted life-years (QALYs), alcohol-related hospitalizations and associated hospitalization costs and alcohol-related deaths, during a 5-year period. FINDINGS Short-term increases in alcohol consumption (increase-1 scenario) resulted in a loss of 79 000 [95% uncertainty interval (UI]) 26 000-201 000] LYs, a loss of 332 000 (104 000-604 000) QALYs and 295 000 (82 000-501 000) more alcohol-related hospitalizations, costing an additional $5.4 billion ($1.5-9.3 billion) over 5 years. Hospitalizations for cirrhosis of the liver accounted for approximately $3.0 billion ($0.9-4.8 billion) in hospitalization costs, more than half the increase across all alcohol-related conditions. Health and cost impacts were more pronounced for older age groups (51+), women and non-Hispanic black individuals. Increasing the duration of pandemic-driven increases in alcohol consumption in the increase-5 scenario resulted in larger impacts. CONCLUSIONS Simulations show that if the increase in alcohol consumption observed in the United States in the first year of the pandemic continues, alcohol-related mortality, morbidity and associated costs will increase substantially over the next 5 years.
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Affiliation(s)
| | - William N. Dowd
- Community Health Research DivisionRTI International, Research Triangle ParkNCUSA
| | | | - Jürgen Rehm
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research InstituteCentre for Addiction and Mental Health (CAMH)TorontoONCanada,Dalla Lana School of Public HealthTorontoONCanada,Institute of Health Policy, Management and Evaluation and Department of PsychiatryUniversity of Toronto (UofT)TorontoONCanada,PAHO/WHO Collaborating Centre for Addiction and Mental HealthTechnische Universität Dresden, Klinische Psychologie and PsychotherapieDresdenGermany
| | - Sameer Imtiaz
- PAHO/WHO Collaborating Centre for Addiction and Mental HealthTechnische Universität Dresden, Klinische Psychologie and PsychotherapieDresdenGermany
| | - Gary A. Zarkin
- Community Health Research DivisionRTI International, Research Triangle ParkNCUSA
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Saur S, Weisel KK, Lang C, Fuhrmann LM, Steins-Loeber S, Enewoldsen N, Reichl D, Zink M, Jakobi F, Rudolph M, Ahnert A, Braunwarth WD, Falkai P, Koller G, Behle N, Hager L, Hillemacher T, Heepe P, Müller FN, Kraus T, Kiderman Y, Horn N, Kornhuber J, Lins S, Spitzer P, Bönsch D, Counot C, Stemmler M, Hildebrand A, Amelung V, Kerkemeyer L, Berking M. App-based maintenance treatment for alcohol use disorder after acute inpatient treatment: Study protocol for a multicentre randomized controlled trial. Internet Interv 2022; 28:100517. [PMID: 35251940 PMCID: PMC8888955 DOI: 10.1016/j.invent.2022.100517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Alcohol use disorder, a prevalent and disabling mental health problem, is often characterized by a chronic disease course. While effective inpatient and aftercare treatment options exist, the transferal of treatment success into everyday life is challenging and many patients remain without further assistance. App-based interventions with human guidance have great potential to support individuals after inpatient treatment, yet evidence on their efficacy remains scarce. OBJECTIVES To develop an app-based intervention with human guidance and evaluate its usability, efficacy, and cost-effectiveness. METHODS Individuals with alcohol use disorder (DSM-5), aged 18 or higher, without history of schizophrenia, undergoing inpatient alcohol use disorder treatment (N = 356) were recruited in eight medical centres in Bavaria, Germany, between December 2019 and August 2021. Participants were randomized in a 1:1 ratio to either receive access to treatment as usual plus an app-based intervention with human guidance (intervention group) or access to treatment as usual plus app-based intervention after the active study phase (waitlist control/TAU group). Telephone-based assessments are conducted by diagnostic interviewers three and six weeks as well as three and six months after randomization. The primary outcome is the relapse risk during the six months after randomization assessed via the Timeline Follow-Back Interview. Secondary outcomes include intervention usage, uptake of aftercare treatments, AUD-related psychopathology, general psychopathology, and quality of life. DISCUSSION This study will provide further insights into the use of app-based interventions with human guidance as maintenance treatment in individuals with AUD. If shown to be efficacious, the intervention may improve AUD treatment by assisting individuals in maintaining inpatient treatment success after returning into their home setting. Due to the ubiquitous use of smartphones, the intervention has the potential to become part of routine AUD care in Germany and countries with similar healthcare systems.
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Affiliation(s)
- Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Corresponding author at: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Nägelsbachstraße 25a, Erlangen, Germany.
| | - Kiona K. Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lukas M. Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Psychiatry, Addiction, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Erlangen, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University Bamberg, Bamberg, Germany
| | - Mathias Zink
- Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Ansbach, Germany
| | - Fabian Jakobi
- Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Ansbach, Germany
| | - Melanie Rudolph
- Department of Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Ansbach, Germany
| | - Andreas Ahnert
- Department of Psychiatry, Addiction, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Erlangen, Germany
| | - Wolf-Dietrich Braunwarth
- Department of Psychiatry, Addiction, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Erlangen, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Nina Behle
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Laura Hager
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Peter Heepe
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Felix-Nicolai Müller
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Thomas Kraus
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Engelthal, Germany
| | - Yaroslav Kiderman
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Engelthal, Germany
| | - Nicola Horn
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Mittelfranken, Engelthal, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Lins
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Spitzer
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Dominikus Bönsch
- Department for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Lohr, Lohr am Main, Germany
| | - Cyril Counot
- Department for Psychiatry, Psychotherapy and Psychosomatics, District Hospital Lohr, Lohr am Main, Germany
| | - Mark Stemmler
- Department of Psychological Assessment, Quantitative Methods and Forensic Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Hildebrand
- Department of Psychological Assessment, Quantitative Methods and Forensic Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Volker Amelung
- inav — Institute for Applied Health Services Research, Berlin, Germany
| | - Linda Kerkemeyer
- inav — Institute for Applied Health Services Research, Berlin, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Wittenberg E, Barbosa C, Hein R, Hudson E, Thornburg B, Bray JW. Health-related quality of life of alcohol use disorder with co-occurring conditions in the US population. Drug Alcohol Depend 2021; 221:108558. [PMID: 33556660 PMCID: PMC8026697 DOI: 10.1016/j.drugalcdep.2021.108558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) commonly co-occurs with other health conditions or other substance use, complicating our understanding of the health-related quality of life (HRQoL) of AUD. We described the HRQoL of alcohol use disorder in the presence of co-occurring conditions and identified the contribution of each. METHODS Secondary analysis of National Epidemiologic Survey on Alcohol and Related Conditions III data, consisting of 36,309 non-institutionalized US adults; descriptive and regression analysis. HRQoL measured via the SF-6D; AUD via the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5); physical, mental health, and substance use disorders/conditions as reported or assessed via AUDADIS-5. RESULTS AUD was independently associated with lower HRQoL for individuals experiencing co-occurring conditions. Compared to no AUD, past year AUD reduced SF-6D score by 0.0304 (SE = 0.0027) and prior-to-past-year AUD reduced SF-6D by 0.0163 (SE = 0.0023). AUD's co-occurring conditions were independently associated with lower HRQoL, beyond the reduction from AUD: any co-occurring physical health condition was associated with a 0.062 point reduction in SF-6D score (SE = 0.0023), any mental health condition with a 0.084 point reduction (SE = 0.0025), and any substance use disorder with a 0.038 point reduction (SE = 0.0023). CONCLUSIONS AUD's association with diminished HRQoL may be explained in large part by the presence of co-occurring conditions among individuals reporting AUD, as these co-occurring conditions are associated with substantial decrements in HRQoL-often eclipsing the magnitude of the decrements associated with AUD alone. Alcohol use interventions endeavoring to improve HRQoL should consider the entirety of an individual to design patient-centered care.
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Affiliation(s)
- Eve Wittenberg
- Center for Health Decision Science, Harvard TH Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA.
| | - Carolina Barbosa
- RTI International, 230 West Monroe Street, Suite 2100, Chicago, IL, 60606, USA.
| | - Riley Hein
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
| | - Emma Hudson
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
| | - Benjamin Thornburg
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
| | - Jeremy W Bray
- Bryan School of Business and Economics, University of North Carolina Greensboro, 462 Bryan Building, PO Box 26170, Greensboro NC 27402, USA.
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