Study shines light on ‘invisible epidemic’

AUDIT-C

That more than half of the subjects scored 3 or more on the AUDIT-C is particularly concerning, because among women, a score of 3 on the 0- to 12-point scale is considered positive for hazardous drinking or active alcohol use disorders, and for men a score of 4 is considered positive.

Even in men, a score of 3 or more could indicate a problem.

The score distribution was 8 percent each for scores 5 and 6, 15 percent each for scores of 1 and 3, 26 percent for a score of 4, and 28 percent for a score of 2, reiterating that the findings likely represent an underestimate of the problem.

Younger age (50-59 and 60-69 years) was associated with a high score of 5 or 6+ points, and older subjects (aged 80+ years) were less represented in the very low (0 or 1) and very high (5 or 6 points or above) score groups; most were in the 2- to 4-point range.

Further men who completed the AUDIT-C were more likely than women to be heavier drinkers (prevalence of higher scores was 24 percent vs. 7 percent among women), Asian subjects were most represented among those with low scores (61 percent in the 2-point category), and black and Asian subjects were less represented in the very high point range.

Finding also varied by education level and income. For example, those who did not complete high school were overrepresented at the high and low score levels, and high scores (6+) were represented among those with lowest and higher income levels.

Lifestyle factors also played a role; smokers were more likely to have higher scores, and higher pack-years were associated with higher scores. Some surprises emerged as well, noting that higher levels of physical activity were associated with midrange scores. Reasons for this are unknown, but speculative possibilities include that exercise and moderate drinking may be correlated lifestyle patterns or perhaps those with higher physical activity think that exercise attenuates the effects of alcohol.

As for depression, a past history of that illness was associated with higher prevalence in the low-score and current mild depression was associated with the lowest- and highest-score categories.

The U-shaped curve persisted after adjusting for confounders, although the magnitude in the higher-score group was attenuated.

Habitual alcohol consumption

Habitual alcohol consumption was measured in all VITAL study subjects, and the preliminary findings also suggest that non-Latino whites (vs. other racial/ethnic groups) and men have the highest prevalence of daily alcohol consumption, and that black and Asian participants have lower prevalence of daily alcohol consumption and are more likely to report never or rarely using alcohol.

Interestingly, in multi-variable models adjusting for demographic and other lifestyle and health factors, weekly or daily alcohol use was associated with lower likelihood of mild depressive symptoms when compared with rate use and non-use of alcohol, and with lower likelihood of problems with interest, sadness, low energy, appetite or weight change, concentration, and psychomotor activity.

As for the relationship between alcohol consumption and mood, there were no significant interactions by age, and generally none by gender, but the threshold for an association between alcohol frequency and cores on the Patient Health Questionnaire (PHQ) – a tool, based in part on DSM criteria, for screening, diagnosing, monitoring, and measuring the severity of depression – did differ by gender. Specifically, weekly use and daily use were significantly associated with lower PHQ scores in men, but only monthly and weekly use were associated with lower PHQ scores in women.

It was noted, however, that the number of subjects who didn’t provide complete information was small (less than 2 percent), it is important, because those with heavy and problem drinking often do not report their alcohol intake.

These early findings underscore the complexity of alcohol use and its effects on older adults. Understanding of the subject and its relationship with depression and anxiety is evolving.

“Getting clues”, adding that “this study will really help a lot, but it’s not a straight-forward relationship. … it’s obviously impacted by clinical and personal factors, and desperately need much greater clarity, because that alcohol and drug use will certainly compromise the treatment of depression and anxiety in later life.”

“It’s something that we really need to be aware of.”