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Smith BT, Warren CM, Andreacchi AT, Schwartz N, Hobin E. The Joint Effect of Education and Alcohol Use on 100% Alcohol-attributable Hospitalization or Death in Canada. Epidemiology 2024; 35:64-73. [PMID: 37756281 DOI: 10.1097/ede.0000000000001674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND Individuals with low socioeconomic position (SEP) experience disproportionately greater alcohol-attributable harm than individuals with high SEP despite similar or less alcohol use (i.e., the alcohol harm paradox). We examined the sex/gender- specific independent and joint effects of education and heavy drinking or volume of alcohol use on 100% alcohol-attributable hospitalization or death. METHODS We conducted a cohort study among 199,125 current and former alcohol users aged 15-64 years from population-representative Canadian Community Health Surveys (2000-2008) linked to hospitalization and mortality records through 2017. We estimated the sex/gender-specific associations between education and heavy drinking or volume of alcohol use and incident 100% alcohol-attributable hospitalization or death using multivariable Fine and Gray subdistribution hazard models with competing risk (non-100% alcohol-attributable deaths), assessing additive interactions using the Synergy Index (S). RESULTS Overall, heavy drinking prevalence and volume of alcohol use were similar or lower in individuals with lower education compared with higher education. Lower education levels compared with a bachelor's degree or above were associated with increased 100% alcohol-attributable hospitalization or death [e.g., less than high school, men: hazard ratio (HR) = 2.78; 95% CI = 2.17, 3.56; women: HR = 2.98; 95% CI = 2.00, 4.44]. We found superadditive joint effects between low education and heavy drinking (men: S = 1.22; 95% CI = 1.14, 1.30; women: S = 1.34; 95% CI = 0.88, 2.04) and low education and higher volume of alcohol use (e.g., excess volume, men: S = 1.30; 95% CI = 1.05, 1.62; women: S = 1.41; 95% CI = 0.77, 2.58), with larger inequities in women than men with similar alcohol use. CONCLUSIONS Our study is consistent with the hypothesis that increased vulnerability to alcohol use among individuals with lower education partially explains the alcohol harm paradox in Canada.
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Affiliation(s)
- Brendan T Smith
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Alessandra T Andreacchi
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada and
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Sidorchuk A, Engström K, Möller J, Gémes K. Predictors of beverage-specific, alcohol consumption trajectories: A Swedish population-based cohort study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:233-249. [PMID: 37255610 PMCID: PMC10225962 DOI: 10.1177/14550725221124386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/22/2022] [Indexed: 09/30/2023] Open
Abstract
Aim: The aim of the study was to examine whether changes in alcohol consumption over time differ according to beverage types, and to what extent socioeconomic, lifestyle and health-related factors predict beverage-specific trajectories in Sweden. Study design: We included participants from the Stockholm Public Health Cohort who were surveyed repeatedly in 2002, 2010 and 2014. Alcohol consumption trajectories were constructed for 13,152 individuals with valid information on amount and frequency of drinking. Preferred beverage types (i.e., beer, wine or spirits) were defined based on the most consumed beverages. Multinomial logistic regression was used to quantify individual predictors of different trajectories, overall and by beverage type. Results: Overall 56.9% of respondents were women, the mean age was 49.2 years, SD (13.1). Wine was cited as the preferred beverage for 72.4% of participants, and stable moderate drinking was the most common trajectory regardless of beverage type (68.2%, 54.9% and 54.2% in individuals with wine, beer and spirits as preferred beverages, respectively). Associations between drinking trajectories and baseline lifestyle factors did not differ by beverage type. Lower socioeconomic position (SEP) was associated with unstable moderate wine drinking (for unskilled manual SEP: adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.23, 1.93), unstable heavy beer drinking (for skilled manual SEP: aOR 1.99, 95% CI 1.14, 3.52; and unskilled manual SEP: aOR 1.72, 95% CI 1.05, 2.82), and former beer drinking trajectory (for skilled manual SEP: aOR 1.81; 95% CI 1.21, 2.72; and unskilled manual SEP: aOR 1.66; 95% CI 1.17, 2.37). Conclusion: Lower SEP was associated with unstable heavy drinking of beer, former beer drinking, and unstable moderate wine drinking trajectories indicating that targeted alcohol prevention programmes need to focus on these groups.
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Affiliation(s)
- Anna Sidorchuk
- Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
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3
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Machine learning nonresponse adjustment of patient-reported opioid consumption data to enable consumption-informed postoperative opioid prescribing guidelines. SURGERY IN PRACTICE AND SCIENCE 2022; 10. [DOI: 10.1016/j.sipas.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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4
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Alcohol-related Outcomes and All-cause Mortality in the Health 2000 Survey by Participation Status and Compared with the Finnish Population. Epidemiology 2021; 31:534-541. [PMID: 32483066 PMCID: PMC7269017 DOI: 10.1097/ede.0000000000001200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the context of declining levels of participation, understanding differences between participants and non-participants in health surveys is increasingly important for reliable measurement of health-related behaviors and their social differentials. This study compared participants and non-participants of the Finnish Health 2000 survey, and participants and a representative sample of the target population, in terms of alcohol-related harms (hospitalizations and deaths) and all-cause mortality. METHODS We individually linked 6,127 survey participants and 1,040 non-participants, aged 30-79, and a register-based population sample (n = 496,079) to 12 years of subsequent administrative hospital discharge and mortality data. We estimated age-standardized rates and rate ratios for each outcome for non-participants and the population sample relative to participants with and without sampling weights by sex and educational attainment. RESULTS Harms and mortality were higher in non-participants, relative to participants for both men (rate ratios = 1.5 [95% confidence interval = 1.2, 1.9] for harms; 1.6 [1.3, 2.0] for mortality) and women (2.7 [1.6, 4.4] harms; 1.7 [1.4, 2.0] mortality). Non-participation bias in harms estimates in women increased with education and in all-cause mortality overall. Age-adjusted comparisons between the population sample and sampling weighted participants were inconclusive for differences by sex; however, there were some large differences by educational attainment level. CONCLUSIONS Rates of harms and mortality in non-participants exceed those in participants. Weighted participants' rates reflected those in the population well by age and sex, but insufficiently by educational attainment. Despite relatively high participation levels (85%), social differentiating factors and levels of harm and mortality were underestimated in the participants.
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Palamar JJ, Acosta P, Cleland CM, Sherman S. Reliability of a Rapid Screener for an Intercept Survey about Drug Use. Subst Use Misuse 2021; 56:1831-1836. [PMID: 34313194 PMCID: PMC8478894 DOI: 10.1080/10826084.2021.1954029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Intercept surveys are a relatively inexpensive method to rapidly collect data on drug use. However, querying use of dozens of drugs can be time-consuming. We determined whether using a rapid screener is efficacious in detecting which participants use drugs and should be offered a full survey which asks more extensively about use. We surveyed 103 adults (age 18-29) on streets of Manhattan, NY in 2019 to test the reliability of a screener which queried past-year use of six drugs. Those reporting any drug use on the screener (and a third of those not reporting drug use) were offered the full survey which queried use of 97 drugs. We compared self-reported use on the screener to the full survey. Self-reported use of ecstasy, cocaine, and LSD had high test-retest reliability (Kappa = 0.90-1.00), and the screener had high sensitivity (1.00) and specificity (0.97-1.00) in detecting use of these drugs. Reliability for marijuana (Kappa = 0.62) and nonmedical opioid use (Kappa = 0.75) was lower. The screener had higher sensitivity (0.94) and lower specificity (0.64) in detecting marijuana use, and lower sensitivity (0.71) and higher specificity (0.98) in detecting nonmedical opioid use. Within the full survey, all participants reporting use of amphetamine (nonmedical use), shrooms, poppers, synthetic cannabinoids, synthetic cathinones, novel psychedelics, ketamine, or GHB reported use of at least one drug queried on the screener. Self-reported use of common drugs on a screener can reliably be used as an inclusion criterion for more extensive intercept surveys about drug use behavior.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, New York, USA
| | - Patricia Acosta
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, New York, USA
| | - Scott Sherman
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, New York, USA
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Klompmaker JO, Hoek G, Bloemsma LD, Marra M, Wijga AH, van den Brink C, Brunekreef B, Lebret E, Gehring U, Janssen NAH. Surrounding green, air pollution, traffic noise exposure and non-accidental and cause-specific mortality. ENVIRONMENT INTERNATIONAL 2020; 134:105341. [PMID: 31783239 DOI: 10.1016/j.envint.2019.105341] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Most previous studies that investigated associations of surrounding green, air pollution or traffic noise with mortality focused on single exposures. OBJECTIVES The aim of this study was to evaluate combined associations of long-term residential exposure to surrounding green, air pollution and traffic noise with total non-accidental and cause-specific mortality. METHODS We linked a national health survey (Public Health Monitor, PHM) conducted in 2012 to the Dutch longitudinal mortality database. Subjects of the survey who were 30 years or older on 1 January 2013 (n = 339,633) were followed from 1 January 2013 till 31 December 2017. We used Cox proportional hazard models to evaluate associations of residential surrounding green (including the average Normalized Difference Vegetation Index (NDVI) in buffers of 300 m and 1000 m), annual average air pollutant concentrations (including particulate matter (PM10, PM2.5), nitrogen dioxide (NO2)) and traffic noise with non-accidental, circulatory disease, respiratory disease, lung cancer and neurodegenerative disease mortality. RESULTS We observed 26,886 non-accidental deaths over 1.627.365 person-years of follow-up. Surrounding green, air pollution and traffic noise exposure were not significantly associated with non-accidental or cause-specific mortality. For non-accidental mortality, we found a hazard ratio (HR) of 0.99 (0.98, 1.01) per IQR increase in NDVI 300 m, a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in NO2, a HR of 0.98 (0.97, 1.00) per IQR increase in PM2.5 and a HR of 0.99 (95% CI: 0.97, 1.01) per IQR increase in road-traffic noise. Analyses restricted to non-movers or excluding subjects aged 85+ years did not change the findings. CONCLUSION We found no evidence for associations of long-term residential exposures to surrounding green, air pollution and traffic noise with non-accidental or cause-specific mortality in a large population based survey in the Netherlands, possibly related to the relatively short follow-up period.
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Affiliation(s)
- Jochem O Klompmaker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Lizan D Bloemsma
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Marten Marra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Alet H Wijga
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Carolien van den Brink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Erik Lebret
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
| | - Nicole A H Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Gray L, Gorman E, White IR, Katikireddi SV, McCartney G, Rutherford L, Leyland AH. Correcting for non-participation bias in health surveys using record-linkage, synthetic observations and pattern mixture modelling. Stat Methods Med Res 2019; 29:1212-1226. [PMID: 31184280 PMCID: PMC7188518 DOI: 10.1177/0962280219854482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Surveys are key means of obtaining policy-relevant information not available from
routine sources. Bias arising from non-participation is typically handled by
applying weights derived from limited socio-demographic characteristics. This
approach neither captures nor adjusts for differences in health and related
behaviours between participants and non-participants within categories. We
addressed non-participation bias in alcohol consumption estimates using novel
methodology applied to 2003 Scottish Health Survey responses record-linked to
prospective administrative data. Differences were identified in
socio-demographic characteristics, alcohol-related harm (hospitalisation or
mortality) and all-cause mortality between survey participants and, from
unlinked administrative sources, the contemporaneous general population of
Scotland. These were used to infer the number of non-participants within each
subgroup defined by socio-demographics and health outcomes. Synthetic
observations for non-participants were then generated, missing only alcohol
consumption. Weekly alcohol consumption values among synthetic non-participants
were multiply imputed under missing at random and missing not at random
assumptions. Relative to estimates adjusted using previously derived weights,
the obtained mean weekly alcohol intake estimates were up to 59% higher among
men and 16% higher among women, depending on the assumptions imposed. This work
demonstrates the universal value of multiple imputation-based methodological
advancement incorporating administrative health data over routine weighting
procedures.
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Affiliation(s)
- Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Emma Gorman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.,Department of Economics, Lancaster University, Lancaster, UK
| | | | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.,Directorate of Public Health and Health Policy, NHS Lothian, Edinburgh, UK
| | | | | | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Keyes KM, Rutherford C, Popham F, Martins SS, Gray L. How Healthy Are Survey Respondents Compared with the General Population?: Using Survey-linked Death Records to Compare Mortality Outcomes. Epidemiology 2018; 29:299-307. [PMID: 29389712 PMCID: PMC5794231 DOI: 10.1097/ede.0000000000000775] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 10/19/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND National surveys are used to capture US health trends and set clinical guidelines, yet the sampling frame often includes those in noninstitutional households, potentially missing those most vulnerable for poor health. Declining response rates in national surveys also represent a challenge, and existing inputs to survey weights have limitations. We compared mortality rates between those who respond to surveys and the general population over time. METHODS Survey respondents from 20 waves of the National Health Interview Survey from 1990 to 2009 who have been linked to death records through 31 December 2011 were included. For each cohort in the survey, we estimated their mortality rates along with that cohort's mortality rate in the census population using vital statistics records, and differences were examined using Poisson models. RESULTS In all years, survey respondents had lower mortality rates compared with the general population when data were both weighted and unweighted. Among men, survey respondents in the weighted sample had 0.86 (95% confidence interval = 0.853, 0.868) times the mortality rate of the general population (among women, RR = 0.887; 95% confidence interval, 0.879, 0.895). Differences in mortality are evident along all points of the life course. Differences have remained relatively stable over time. CONCLUSION Survey respondents have lower death rates than the general US population, suggesting that they are a systematically healthier source population. Incorporating nonhousehold samples and revised weighting strategies to account for sample frame exclusion and nonresponse may allow for more rigorous estimation of the US population's health.
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Affiliation(s)
- Katherine M. Keyes
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Psychiatry, Columbia University Medical Center, New York, NY; and MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Rutherford
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Psychiatry, Columbia University Medical Center, New York, NY; and MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Frank Popham
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Psychiatry, Columbia University Medical Center, New York, NY; and MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Silvia S. Martins
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Psychiatry, Columbia University Medical Center, New York, NY; and MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Linsay Gray
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Psychiatry, Columbia University Medical Center, New York, NY; and MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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9
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Gorman E, Leyland AH, McCartney G, Katikireddi SV, Rutherford L, Graham L, Robinson M, Gray L. Adjustment for survey non-representativeness using record-linkage: refined estimates of alcohol consumption by deprivation in Scotland. Addiction 2017; 112:1270-1280. [PMID: 28276110 PMCID: PMC5467727 DOI: 10.1111/add.13797] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/29/2016] [Accepted: 02/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Analytical approaches to addressing survey non-participation bias typically use only demographic information to improve estimates. We applied a novel methodology which uses health information from data linkage to adjust for non-representativeness. We illustrate the method by presenting adjusted alcohol consumption estimates for Scotland. DESIGN Data on consenting respondents to the Scottish Health Surveys (SHeSs) 1995-2010 were linked confidentially to routinely collected hospital admission and mortality records. Synthetic observations representing non-respondents were created using general population data. Multiple imputation was performed to compute adjusted alcohol estimates given a range of assumptions about the missing data. Adjusted estimates of mean weekly consumption were additionally calibrated to per-capita alcohol sales data. SETTING Scotland. PARTICIPANTS 13 936 male and 18 021 female respondents to the SHeSs 1995-2010, aged 20-64 years. MEASUREMENTS Weekly alcohol consumption, non-, binge- and problem-drinking. FINDINGS Initial adjustment for non-response resulted in estimates of mean weekly consumption that were elevated by up to 17.8% [26.5 units (18.6-34.4)] compared with corrections based solely on socio-demographic data [22.5 (17.7-27.3)]; other drinking behaviour estimates were little changed. Under more extreme assumptions the overall difference was up to 53%, and calibrating to sales estimates resulted in up to 88% difference. Increases were especially pronounced among males in deprived areas. CONCLUSIONS The use of routinely collected health data to reduce bias arising from survey non-response resulted in higher alcohol consumption estimates among working-age males in Scotland, with less impact for females. This new method of bias reduction can be generalized to other surveys to improve estimates of alternative harmful behaviours.
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Affiliation(s)
- Emma Gorman
- MRC/CSO Social and Public Health Sciences Unit, University of GlasgowGlasgowUK,Department of EconomicsLancaster UniversityLancasterUK
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of GlasgowGlasgowUK
| | | | | | | | - Lesley Graham
- Information Services DivisionNHS National Services ScotlandEdinburghUK
| | - Mark Robinson
- Department of EconomicsLancaster UniversityLancasterUK
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of GlasgowGlasgowUK,Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
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Lundin A, Hallgren M, Balliu N, Forsell Y. The use of alcohol use disorders identification test (AUDIT) in detecting alcohol use disorder and risk drinking in the general population: validation of AUDIT using schedules for clinical assessment in neuropsychiatry. Alcohol Clin Exp Res 2016; 39:158-65. [PMID: 25623414 DOI: 10.1111/acer.12593] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The alcohol use disorders identification test (AUDIT) and AUDIT-Consumption (AUDIT-C) are commonly used in population surveys but there are few validations studies in the general population. Validity should be estimated in samples close to the targeted population and setting. This study aims to validate AUDIT and AUDIT-C in a general population sample (PART) in Stockholm, Sweden. METHODS We used a general population subsample age 20 to 64 that answered a postal questionnaire including AUDIT who later participated in a psychiatric interview (n = 1,093). Interviews using Schedules for Clinical Assessment in Neuropsychiatry was used as criterion standard. Diagnoses were set according to the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Agreement between the diagnostic test and criterion standard was measured with area under the receiver operator characteristics curve (AUC). RESULTS A total of 1,086 (450 men and 636 women) of the interview participants completed AUDIT. There were 96 individuals with DSM-IV-alcohol dependence, 36 DSM-IV-Alcohol Abuse, and 153 Risk drinkers. AUCs were for DSM-IV-alcohol use disorder 0.90 (AUDIT-C 0.85); DSM-IV-dependence 0.94 (AUDIT-C 0.89); risk drinking 0.80 (AUDIT-C 0.80); and any criterion 0.87 (AUDIT-C 0.84). CONCLUSIONS In this general population sample, AUDIT and AUDIT-C performed outstanding or excellent in identifying dependency, risk drinking, alcohol use disorder, any disorder, or risk drinking.
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Affiliation(s)
- Andreas Lundin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Shortreed SM, Von Korff M, Thielke S, LeResche L, Saunders K, Rosenberg D, Turner JA. Electronic Health Records to Evaluate and Account for Non-response Bias: A Survey of Patients Using Chronic Opioid Therapy. OBSERVATIONAL STUDIES 2016; 2:24-38. [PMID: 28042621 PMCID: PMC5193131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In observational studies concerning drug use and misuse, persons misusing drugs may be less likely to respond to surveys. However, little is known about differences in drug use and drug misuse risk factors between survey respondents and nonrespondents. METHODS Using electronic health record (EHR) data, we compared respondents and non-respondents in a telephone survey of middle-aged and older chronic opioid therapy patients to assess predictors of interview nonresponse. We compared general patient characteristics, specific opioid misuse risk factors, and patterns of opioid use associated with increased risk of opioid misuse. Inverse probability weights were calculated to account for nonresponse bias by EHR-measured covariates. EHR-measured covariate distributions for the full sample (nonrespondents and respondents), the unweighted respondent sample, and the inverse probability weighted respondent sample are reported. We present weighted and unweighted prevalence of self-reported opioid misuse risk factors. RESULTS Among 2489 potentially eligible patients, 1477 (59.3%) completed interviews. Response rates differed with age (45-54 years, 51.8%; 55-64 years, 58.7%; 65-74 years, 67.9%; and 75 years or older, 59.9%). Tobacco users had lower response rates than did nonusers (53.5% versus 60.9%). Charlson comorbidity score was also related to response rates. Individuals with a Charlson score of 2 had the highest response rate at 65.6%; response rates were lower amoung patients with the lowest (the patients with the fewest health conditions had response rates of 56.7-60.0%) and the highest Charlson scores (patients with the most health conditions had response rates of 52.2-56.0%). These bivariate relationships persisted in adjusted multivariable logistic regression models predicting survey response. Response rates of persons with and without specific opioid misuse risk factors were similar (e.g., 58.7% for persons with substance abuse diagnoses, 59.4% for those without). Opioid use patterns associated with opioid misuse did not predict response rates (e.g., 60.6% versus 59.2% for those receiving versus not receiving opioids from 3 or more physicians outside their primary care clinic). Very few patient characteristics predicted non-response; thus, inverse probability weights accounting for nonresponse had little impact on the distributions of EHR-measured covariates or self-reported measures related to opioid use and misuse. CONCLUSIONS Response rates differed by characteristics that predict nonresponse in general health surveys (age, tobacco use), but did not appear to differ by specific patient or drug use risk factors for prescription opioid misuse among middle- and older-aged chronic opioid therapy patients. When observational studies are conducted in health plan populations, electronic health records may be used to evaluate nonresponse bias and to adjust for variables predicting interview nonresponse, complementing other research uses of EHR data in observational studies.
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Affiliation(s)
- Susan M Shortreed
- Group Health Research Institute, Seattle, WA, USA., Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA., Geriatric Research, Education, and Clinical Center, Puget Sound Veterans Affairs Medical Center, Seattle, WA, USA
| | - Linda LeResche
- Department of Oral Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences; Department of Rehabilitation Medicine; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Kelfve S, Ahacic K. Bias in estimates of alcohol use among older people: selection effects due to design, health, and cohort replacement. BMC Public Health 2015; 15:769. [PMID: 26260667 PMCID: PMC4531847 DOI: 10.1186/s12889-015-2114-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022] Open
Abstract
Background There is a growing awareness of the need to include the oldest age groups in the epidemiological monitoring of alcohol consumption. This poses a number of challenges and this study sets out to examine the possible selection effects due to survey design, health status, and cohort replacement on estimates of alcohol use among the oldest old. Methods Analyses were based on three repeated cross-sectional interview surveys from 1992, 2002 and 2011, with relatively high response rates (86 %). The samples were nationally representative of the Swedish population aged 77+ (total n = 2022). Current alcohol use was assessed by the question “How often do you drink alcoholic beverages, such as wine, beer or spirits?” Alcohol use was examined in relation to survey design (response rate, use of proxy interviews and telephone interviews), health (institutional living, limitations with Activities of Daily Living and mobility problems) and birth cohort (in relation to age and period). Two outcomes were studied using binary and ordered logistic regression; use of alcohol and frequency of use among alcohol users. Results Higher estimates of alcohol use, as well as more frequent use, were associated with lower response rates, not using proxy interviews and exclusion of institutionalized respondents. When adjusted for health, none of these factors related to the survey design were significant. Moreover, the increase in alcohol use during the period was fully explained by cohort replacement. This cohort effect was also at least partially confounded by survey design and health effects. Results were similar for both outcomes. Conclusions Survey non-participation in old age is likely to be associated with poor health and low alcohol consumption. Failure to include institutionalized respondents or those who are difficult to recruit is likely to lead to an overestimation of alcohol consumption, whereas basing prevalence on older data, at least in Sweden, is likely to underestimate the alcohol use of the oldest old. Trends in alcohol consumption in old age are highly sensitive for cohort effects. When analysing age-period-cohort effects, it is important to be aware of these health and design issues as they may lead to incorrect conclusions.
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Affiliation(s)
- Susanne Kelfve
- Aging Research Center, Karolinska Institutet & Stockholm University, Gävlegatan 16, Stockholm, SE-113 30, Sweden. .,Department of Sociology, Stockholm University, Stockholm, Sweden.
| | - Kozma Ahacic
- Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, Stockholm, Sweden. .,Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Nurmela K, Heikkinen V, Hokkanen R, Ylinen A, Uitti J, Mattila A, Joukamaa M, Virtanen P. Identification of alcohol abuse and transition from long-term unemployment to disability pension. Scand J Public Health 2015; 43:518-24. [PMID: 25930940 DOI: 10.1177/1403494815580149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 11/15/2022]
Abstract
AIMS The aim of the study was to reveal potential gaps and inconsistencies in the identification of alcohol abuse in health care and in employment services and to analyse the granting of disability pensions with respect to the alcohol abuse identification pattern. METHODS The material consisted of documentary information on 505 long-term unemployed subjects with low employability sent to the development project entitled 'Eligibility for a Disability Pension' in 2001-2006 in Finland. The dichotomous variables 'Alcohol abuse identified in employment services' and 'Alcohol abuse identified in health care' were cross-tabulated to obtain a four-class variable 'Alcohol abuse identification pattern'. Logistic regression analyses were conducted to ascertain the association of alcohol abuse identification pattern with the granting of disability pensions. RESULTS Alcohol abuse was detected by both health care and employment services in 47% of those identified as abusers (41% of examinees). Each service systems also identified cases that the other did not. When alcohol abuse was identified in health care only, the OR for a disability pension being granted was 2.8 (95% CI 1.5-5.2) compared with applicants without identified alcohol abuse. The result remained the same and statistically significant after adjusting for confounders. CONCLUSIONS Alcohol abuse identified in health care was positively associated with the granting of a disability pension. Closer co-operation between employment services and health care could help to identify those long-term unemployed individuals with impaired work ability in need of thorough medical examination.
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Affiliation(s)
- Kirsti Nurmela
- School of Health Sciences, University of Tampere, Tampere, Finland Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland Non-Institutional Mental Health Services, City of Tampere, Finland
| | - Virpi Heikkinen
- School of Health Sciences, University of Tampere, Tampere, Finland Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Risto Hokkanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Aarne Ylinen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Jukka Uitti
- School of Health Sciences, University of Tampere, Tampere, Finland Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland Finnish Institute of Occupational Health, Tampere, Finland
| | - Aino Mattila
- Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Matti Joukamaa
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Pekka Virtanen
- School of Health Sciences, University of Tampere, Tampere, Finland Institute of advanced social research, University of Tampere, Tampere, Finland
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Hill-Kapturczak N, Roache JD, Liang Y, Karns TE, Cates SE, Dougherty DM. Accounting for sex-related differences in the estimation of breath alcohol concentrations using transdermal alcohol monitoring. Psychopharmacology (Berl) 2015; 232:115-23. [PMID: 24923985 PMCID: PMC4265311 DOI: 10.1007/s00213-014-3644-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/24/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE Previously, we reported methods to estimate peak breath alcohol concentrations (BrAC) from transdermal alcohol concentrations (TAC) under conditions where alcohol consumption was controlled to produce similar BrAC levels in both sexes. OBJECTIVE This study characterized differences in the relationship between BrAC and TAC as a function of sex and developed a model to predict peak BrAC that accounts for known sex differences in peak BrAC. METHODS TAC and BrAC were monitored during the consumption of a varying number of beers on different days. Both men (n=11) and women (n=10) consumed one, two, three, four, and five beers at the same rate in a 2-h period. Sex and sex-related variables were considered for inclusion in a multilevel model to develop an equation to estimate peak BrAC levels from TAC. RESULTS While peak BrAC levels were significantly higher in women than men, sex differences were not significant in observed TAC levels. This lack of correspondence was evidenced by significant sex differences in the relationship between peak TAC and peak BrAC. The best model to estimate peak BrAC accounted for sex-related differences by including peak TAC, time-to-peak TAC, and sex. This model was further validated using previously collected data. CONCLUSIONS The relationship between peak TAC and actual peak BrAC differs between men and women, and these differences can be accounted for in a statistical model to better estimate peak BrAC. Further studies are required to extend these estimates of peak BrAC to the outpatient environment where naturalistic drinking occurs.
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Affiliation(s)
| | | | | | | | | | - Donald M. Dougherty
- Corresponding author: Donald M. Dougherty, Ph.D., Department of Psychiatry, The University of Texas Health Science Center at San Antonio, NRLC MC 7793, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA, , Phone (210) 567-2745; Fax (210) 567-2748
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Gorman E, Leyland AH, McCartney G, White IR, Katikireddi SV, Rutherford L, Graham L, Gray L. Assessing the representativeness of population-sampled health surveys through linkage to administrative data on alcohol-related outcomes. Am J Epidemiol 2014; 180:941-8. [PMID: 25227767 PMCID: PMC4207717 DOI: 10.1093/aje/kwu207] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Health surveys are an important resource for monitoring population health, but selective nonresponse may impede valid inference. This study aimed to assess nonresponse bias in a population-sampled health survey in Scotland, with a focus on alcohol-related outcomes. Nonresponse bias was assessed by examining whether rates of alcohol-related harm (i.e., hospitalization or death) and all-cause mortality among respondents to the Scottish Health Surveys (from 1995 to 2010) were equivalent to those in the general population, and whether the extent of any bias varied according to sociodemographic attributes or over time. Data from consenting respondents (aged 20–64 years) to 6 Scottish Health Surveys were confidentially linked to death and hospitalization records and compared with general population counterparts. Directly age-standardized incidence rates of alcohol-related harm and all-cause mortality were lower among Scottish Health Survey respondents compared with the general population. For all years combined, the survey-to-population rate ratios were 0.69 (95% confidence interval: 0.61, 0.76) for the incidence of alcohol-related harm and 0.89 (95% confidence interval: 0.83, 0.96) for all-cause mortality. Bias was more pronounced among persons residing in more deprived areas; limited evidence was found for regional or temporal variation. This suggests that corresponding underestimation of population rates of alcohol consumption is likely to be socially patterned.
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Affiliation(s)
- Emma Gorman
- Correspondence to Emma Gorman, Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, College of Medical, Veterinary, and Life Sciences, University of Glasgow, 200 Renfield Street, Glasgow G2 3QB, United Kingdom (e-mail: )
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Ahacic K, Kennison RF, Kåreholt I. Alcohol abstinence, non-hazardous use and hazardous use a decade after alcohol-related hospitalization: registry data linked to population-based representative postal surveys. BMC Public Health 2014; 14:874. [PMID: 25150844 PMCID: PMC4153888 DOI: 10.1186/1471-2458-14-874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/18/2014] [Indexed: 12/20/2022] Open
Abstract
Background Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade. Method Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23–84 years at follow-up. Results Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population – and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population. Conclusions Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence.
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Affiliation(s)
- Kozma Ahacic
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden.
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Ansker FG, Helgason AR, Ahacic K. The beliefs about pros and cons of drinking and intention to change among hazardous and moderate alcohol users: a population-based cross-sectional study. Eur J Public Health 2014; 24:566-71. [PMID: 24567291 PMCID: PMC4110956 DOI: 10.1093/eurpub/cku007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Fundamental to supporting hazardous alcohol users are the rationales for reducing alcohol intake highlighted by the users themselves. This study analyses the relative importance of beliefs about pros and cons of drinking in relation to having an intention to reduce intake among both hazardous and moderate alcohol users. METHODS Intention to change was assessed in a representative sample of Stockholm's population (n = 4278, response rate 56.5%). Alcohol use was assessed using the Alcohol Use Disorders Identification Test measure. A decisional balance inventory was used to examine various beliefs about the pros and cons of drinking, which covered affect changes, social gains and losses, and possible adverse effects. Independent correlations were determined by logistic regression using a backward exclusion procedure (P > 0.05). RESULTS Higher ratings of importance were generally related to intent, whether or not the contrast was with having no intent or already having made a reduction. This was especially true for hazardous users. Only two beliefs were independently correlated with change among hazardous users: 'Drinking could get me addicted' and 'Drinking makes me more relaxed/less tense' (pseudo-R2 < 0.1). Among moderate users, there was no uniform pattern in the relationships. CONCLUSIONS Unexpectedly, hazardous users with an intent to change rated pro arguments as more important than those with no intent to change. Of the investigated pros and cons, only a few were independently related to intention to change drinking behaviour. These arguments provide interesting topics in consultations. Little support was found for any rational decision making behind the intention to reduce alcohol intake.
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Affiliation(s)
| | - Asgeir R Helgason
- 2 Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden3 Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, 171 29 Solna, Sweden4 Reykjavik University, Iceland
| | - Kozma Ahacic
- 2 Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden3 Centre for Epidemiology and Community Medicine, Health Care Services, Stockholm County Council, 171 29 Solna, Sweden
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