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The effects of smoking, regular drinking, and unhealthy weight on health care utilization in China. BMC Public Health 2021; 21:2268. [PMID: 34895186 PMCID: PMC8666049 DOI: 10.1186/s12889-021-12309-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Preventive risk factors such as smoking, drinking, and unhealthy weight have contributed to the accelerated rise in noncommunicable chronic diseases, which are dominant drivers of health care utilization and spending in China. However, few studies have been conducted using a large longitudinal dataset to explore the impact of such preventive risk factors on health care utilization. Therefore, this study aimed to ascertain the effects of smoking, regular drinking, and unhealthy weight on health care utilization in China. Methods This research was a longitudinal study using data from five waves of the China Family Panel Studies (CFPS) conducted between 2010 and 2018, and the final sample consisted of 63,260 observations (12,652 participants) across all five waves of data collection. Health care utilization was measured from two perspectives: outpatient utilization and inpatient utilization. Smoking status was categorized as never smoker, former smoker, or current smoker. Unhealthy weight was classified based on the participants’ body mass index. A fixed effects logistic regression model was used for the analysis. Results The results of fixed effects logistic regression showed that current and former smokers were approximately 1.9 times and 2.0 times more likely to use outpatient care than those who never smoked, respectively (odds ratio (OR) = 1.88, p < 0.05; OR = 2.03, p < 0.05). Obese people were approximately 1.3 times more likely to use outpatient care than healthy weight people (OR = 1.26, p < 0.05). Moreover, the results show that compared to those who never smoked, for current and former smokers, the odds of being hospitalized increased by 42.2 and 198.2%, respectively (OR = 1.42; p < 0.1, OR = 2.98; p < 0.05). Compared to healthy weight people, overweight and obese people were also more likely to be hospitalized (OR = 1.11; p < 0.1, OR = 1.18; p < 0.1, respectively). Conclusion Among Chinese adults, current and former smokers were more likely to use outpatient and inpatient care than those who had never smoked. Moreover, compared to healthy weight people, obese people were more likely to use outpatient and inpatient care, and overweight people were more likely to use inpatient care. These results may have important implications that support the government in making health care resource allocation decisions.
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Khayambashi S, Salter A, Tyry T, Cutter GR, Fox RJ, Marrie RA. Gender identity and sexual orientation affect health care satisfaction, but not utilization, in persons with Multiple Sclerosis. Mult Scler Relat Disord 2020; 37:101440. [DOI: 10.1016/j.msard.2019.101440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
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Costanzo S, Mukamal KJ, Di Castelnuovo A, Bonaccio M, Olivieri M, Persichillo M, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Alcohol consumption and hospitalization burden in an adult Italian population: prospective results from the Moli-sani study. Addiction 2019; 114:636-650. [PMID: 30548347 DOI: 10.1111/add.14490] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/23/2018] [Accepted: 10/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Epidemiological evidence on the impact of different alcohol drinking patterns on health-care systems or hospitalizations is sparse. We investigated how the different average volumes of alcohol consumed relate to all-cause and cause-specific hospitalizations. DESIGN Prospective cohort study (baseline 2005-10) linked to a registry of hospital discharge records to identify hospitalizations at follow-up (December 2013). SETTING Molise region, Italy. PARTICIPANTS A total of 20 682 individuals (48% men, age ≥ 35 years) who participated in the Moli-sani Study and were free from cardiovascular disease or cancer at baseline. MEASUREMENTS The alcohol volume consumed in the year before enrolment was classified as: life-time abstainers, former drinkers, occasional drinkers and current drinkers who drank 1-12 (referent), 12.1-24, 24.1-48 and > 48 g/day of alcohol. Cause-specific hospitalizations were assigned by Italian Diagnosis Related Groups classification or by ICD-9 code of main admission diagnoses. Incidence rate ratios (IRR) of hospitalization were estimated by Poisson regression, taking into account the total number of admissions that occurred during the follow-up per person. FINDINGS During a median follow-up of 6.3 years, 12 996 multiple hospital admissions occurred. In multivariable analyses, life-time abstainers and former drinkers had higher rates of all-cause [IRR = 1.11, 95% confidence interval (CI) = 1.05-1.17 and IRR = 1.19, 95% CI = 1.02-1.31, respectively] and vascular (IRR = 1.14, 95% CI = 1.02-1.27 and IRR = 1.48, 95% CI = 1.24-1.76, respectively) hospitalizations compared with light alcohol consumers. Alcohol consumption > 48 g/day was associated with a higher rate of hospitalization for both alcohol-related diseases (IRR = 1.74, 95% CI = 1.32-2.29) and cancer (IRR = 1.36, 95% CI = 1.12-1.65). The magnitude of the association between heavier alcohol intake and hospitalization tended to be greater in smokers than non-smokers. No associations were observed with hospitalization for trauma or neurodegenerative diseases. CONCLUSIONS Moderate alcohol consumption appears to have a modest but complex impact on global hospitalization burden. Heavier drinkers have a higher rate of hospitalization for all causes, including alcohol-related diseases and cancer, a risk that appears to be further magnified by concurrent smoking.
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Affiliation(s)
- Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Kenneth J Mukamal
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | | | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy
| | | | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy.,Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
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Miquel L, Rehm J, Shield KD, Vela E, Bustins M, Segura L, Colom J, Anderson P, Gual A. Alcohol, tobacco and health care costs: a population-wide cohort study (n = 606 947 patients) of current drinkers based on medical and administrative health records from Catalonia. Eur J Public Health 2018; 28:674-680. [PMID: 29325000 DOI: 10.1093/eurpub/ckx236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Most cost of illness studies are based on models where information on exposure is combined with risk information from meta-analyses, and the resulting attributable fractions are applied to the number of cases. Methods This study presents data on alcohol and tobacco use for 2011 and 2012 obtained from a routine medical practice in Catalonia of 606 947 patients, 18 years of age and older, as compared with health care costs for 2013 (all costs from the public health care system: primary health care visits, hospital admissions, laboratory and medical tests, outpatient visits to specialists, emergency department visits and pharmacy expenses). Quasi-Poisson regressions were used to assess the association between alcohol consumption and smoking status and health care costs (adjusted for age and socio-economic status). Results Resulting health care costs per person per year amounted to 1290 Euros in 2013, and were 20.1% higher for men than for women. Sex, alcohol consumption, tobacco use and socio-economic status were all associated with health care costs. In particular, alcohol consumption had a positive dose-response association with health care costs. Similarly, both smokers and former smokers had higher health care costs than did people who never smoked. Conclusions Alcohol and tobacco use had modest and large impacts respectively on health care costs, confirming the results of previous ecological modelling analyses. Reductions of alcohol consumption and smoking through public policies and via early identification and brief interventions would likely be associated with reductions in health care costs.
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Affiliation(s)
- Laia Miquel
- Grup de Recerca en Addiccions Clínic, Institut Clínic de Neurociències, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
- Spanish Network of Addictive Disorders (RTA), Madrid, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada
- WHO/PAHO Collaborating Centre in Addiction and Mental Health, Toronto, ON, Canada
- Epidemiological Research Unit, Klinische Psychologie & Psychotherapie, Technische Universität Dresden, Dresden, Germany
- Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Kevin D Shield
- WHO/PAHO Collaborating Centre in Addiction and Mental Health, Toronto, ON, Canada
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Emili Vela
- Grup de Recerca en Addiccions Clínic, Institut Clínic de Neurociències, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Bustins
- Divisió d'Anàlisi de la Demanda i l'Activitat, Servei Català de la Salut, Barcelona, Spain
| | - Lidia Segura
- Program on Substance Abuse, Department of Health, Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain
| | - Joan Colom
- Program on Substance Abuse, Department of Health, Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain
| | - Peter Anderson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, MD, The Netherlands
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Institut Clínic de Neurociències, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer, Barcelona, Spain
- Spanish Network of Addictive Disorders (RTA), Madrid, Spain
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Wherry LR, Burns ME, Leininger LJ. Using self-reported health measures to predict high-need cases among Medicaid-eligible adults. Health Serv Res 2014; 49 Suppl 2:2147-72. [PMID: 25130916 PMCID: PMC4241135 DOI: 10.1111/1475-6773.12222] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the ability of different self-reported health (SRH) measures to prospectively identify individuals with high future health care needs among adults eligible for Medicaid. DATA SOURCES The 1997-2008 rounds of the National Health Interview Survey linked to the 1998-2009 rounds of the Medical Expenditure Panel Survey (n = 6,725). STUDY DESIGN Multivariate logistic regression models are fitted for the following outcomes: having an inpatient visit; membership in the top decile of emergency room utilization; and membership in the top cost decile. We examine the incremental predictive ability of six different SRH domains (health conditions, mental health, access to care, health behaviors, health-related quality of life [HRQOL], and prior utilization) over a baseline model with sociodemographic characteristics. Models are evaluated using the c-statistic, integrated discrimination improvement, sensitivity, specificity, and predictive values. PRINCIPAL FINDINGS Self-reports of prior utilization provide the greatest predictive improvement, followed by information on health conditions and HRQOL. Models including these three domains meet the standard threshold of acceptability (c-statistics range from 0.703 to 0.751). CONCLUSIONS SRH measures provide a promising way to prospectively profile Medicaid-eligible adults by likely health care needs.
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Affiliation(s)
- Laura R Wherry
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of CaliforniaLos Angeles, CA
| | - Marguerite E Burns
- Department of Population Health Sciences, University of Wisconsin-MadisonMadison, WI
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Yan T, Xu H, Ettner SL, Barnes AJ, Moore AA. At-risk drinking and outpatient healthcare expenditures in older adults. J Am Geriatr Soc 2014; 62:325-8. [PMID: 24417471 DOI: 10.1111/jgs.12636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare 12-month outpatient healthcare expenditures of at-risk and not-at-risk drinkers aged 60 and older. DESIGN Secondary analysis of data from Project Senior Health and Alcohol Risk Education, a cluster, randomized trial to test the efficacy of an intervention to reduce at-risk drinking. SETTING Seven primary care clinics in or near Santa Barbara, California. PARTICIPANTS Current drinkers aged 60 and older who completed a baseline survey (N = 2,779) and did not receive the study intervention, including 628 at-risk drinkers and 2,151 not-at-risk drinkers. MEASUREMENTS Comparisons of at-risk and not-at-risk drinkers for baseline demographic characteristics, health indicators, alcohol consumption, and adjusted and unadjusted outpatient healthcare expenditures incurred over 12 months after baseline. RESULTS At-risk drinkers were younger, more often male, and more likely to be married and had higher education and incomes than not-at-risk drinkers. Unadjusted 12-month mean outpatient healthcare expenditures were $1,333 ± 2,973 for at-risk drinkers and $1,417 ± 2,952 for the not-at-risk drinkers. There were no statistically significant differences in expenditures between groups before and after controlling for sociodemographic and health characteristics. CONCLUSION In this short-term study, no adjusted differences in healthcare expenditures were observed between at-risk and not-at-risk older drinkers. Future study is warranted to determine the role of at-risk drinking in long-term healthcare expenditures in older adults.
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Affiliation(s)
- Tingjian Yan
- Cedar-Sinai Medical Center, Los Angeles, California
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Comparison of Health Service Use Among Veterans With Methamphetamine Versus Alcohol Use Disorders. J Addict Med 2014; 8:47-52. [DOI: 10.1097/adm.0000000000000005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme. S Afr Med J 2013; 103:840-4. [PMID: 24148168 DOI: 10.7196/samj.7260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 07/19/2013] [Accepted: 07/30/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Health risks such as tobacco use, excessive alcohol consumption and unhealthy body weight contribute to the development of chronic health problems. OBJECTIVE To estimate the associations of tobacco use, excessive alcohol consumption and obesity with healthcare expenditure and chronic diseases among South Africans on a comprehensive medical scheme. METHODS We performed a cross-sectional analysis of health survey and medical claims data for 70 000 South Africans during 2010. RESULTS Moderately obese individuals, with a body mass index (BMI) of 30 - 35 kg/m2 averaged R2 300 (11%) higher annual medical expenditure in the year 2010 than never-smokers with a BMI <30 kg/m2. This increase is comparable with being a current or past smoker (expenditure increase by R2 600; 13%). Severely obese individuals (BMI >35 kg/m2), however, had increased healthcare costs of R4 400 (23% increase). This exceeds the difference between a 40- and a 50-year-old (increase of R3 200). Being overweight or excessive consumption of alcohol was not significantly associated with medical expenditures. Absolute and relative excess expenditures associated with these health risks are higher among older individuals. In the 54 - 69-year age group, estimated additional expenses were R6 200 for smoking (20% increase over never-smokers with BMI <30 kg/m2), R6 600 for moderate obesity (21%) and R15 800 for severe obesity (51% increase). Overweight or heavy drinking was not statistically significantly associated with healthcare expenditure. CONCLUSION Obesity and tobacco use are associated with significantly increased healthcare expenditure. Severe obesity doubles these excess costs.
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Miller CJ, Abraham KM, Bajor LA, Lai Z, Kim HM, Nord KM, Goodrich DE, Bauer MS, Kilbourne AM. Quality of life among patients with bipolar disorder in primary care versus community mental health settings. J Affect Disord 2013; 146:100-5. [PMID: 22981021 PMCID: PMC3554842 DOI: 10.1016/j.jad.2012.08.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Bipolar disorder is associated with functional impairment across a number of domains, including health-related quality of life (HRQOL). Many patients are treated exclusively in primary care (PC) settings, yet little is known how HRQOL outcomes compare between PC and community mental health (CMH) settings. This study aimed to explore the correlates of HRQOL across treatment settings using baseline data from a multisite, randomized controlled trial for adults with bipolar disorder. METHODS HRQOL was measured using the SF-12 physical (PCS) and mental (MCS) composite scale scores. Independent sample t-tests were calculated to compare differences in HRQOL between settings. Multivariate regression models then examined the effect of treatment setting on HRQOL, adjusting for covariate demographic factors, mood symptoms (Internal State Scale), hazardous drinking (AUDIT-C), and substance abuse. RESULTS A total of 384 enrolled participants completed baseline surveys. MCS and PCS scores reflected similar impairment in HRQOL across PC and CMH settings (p=0.98 and p=0.49, respectively). Depressive symptoms were associated with lower MCS scores (B=-0.68, p<0.001) while arthritis/chronic pain was strongly related to lower PCS scores (B=-5.23, p<0.001). LIMITATIONS This study lacked a formal diagnostic interview, relied on cross-sectional self-report, and sampled from a small number of sites in two states. DISCUSSION Participants reported similar impairments in both mental and physical HRQOL in PC and CMH treatment settings, emphasizing the need for integrated care for patients with bipolar disorder regardless of where they present for treatment.
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Affiliation(s)
- Christopher J Miller
- Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S. Huntington Ave. 152M, Boston, MA 02130, United States.
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Kilbourne BJ, Cummings SM, Levine R. Alcohol diagnoses among older Tennessee Medicare beneficiaries: race and gender differences. Int J Geriatr Psychiatry 2012; 27:483-90. [PMID: 21618286 DOI: 10.1002/gps.2740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 03/29/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND These analyses bolster a sparse body of research focusing on the rate of alcohol disorders among older adults, particularly race and gender subgroups. METHODS We based the study on cross-sectional data from all Medicare billed physician/patient encounters. Analyses of these data included cross-tabulations, difference of means tests, and difference of proportions tests, logistic regression and multinomial logistic regression. These analyses were based Medicare billing records from physician/patient encounters in Tennessee. Data included Tennessee Medicare billings beneficiaries enrolled in Medicare Part B, who saw a physician at least once in 2000. Patients with billings containing ICD-9 codes: 303 (alcohol abuse), 305 (alcohol dependence), 291 (alcohol psychosis), or 571.1-571.3 (alcohol-related liver disease including cirrhosis of the liver) as to primary diagnosis were considered alcohol-disordered. RESULTS Analyses reveal the overall rate of alcohol disorders, subgroup variation in rates and differences in pattern of specific disorders. Merely 0.04% of Tennessee Medicare beneficiaries were diagnosed with any type of alcoholism, a rate much lower than those reported in previous studies. Rates of alcohol disorders varied across groups, with significantly higher rates for Black men. The type alcohol disorder also varied across groups. CONCLUSIONS Many encounters with the medical system result in missed opportunities to identify and treat alcohol disorders, a significant risk factor among older adults. Alcoholism both triggers and exacerbates many chronic conditions among older adults. The earlier in the disease trajectory the more of these conditions could be prevented or more efficiently managed, resulting in substantial savings in health care costs.
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Affiliation(s)
- Barbara Jean Kilbourne
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA.
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Li Y, Jensen GA. Effects of drinking on hospital stays and emergency room visits among older adults. J Aging Health 2011; 24:67-91. [PMID: 21383225 DOI: 10.1177/0898264311398394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate whether alcohol drinking influences emergency room (ER) visits or hospital admissions among adults aged 65 and older. METHOD Data from two independent national surveys are used to estimate multivariate logit models that quantify the relationship between drinking and ER visits and hospital admissions. The authors distinguish between ER visits linked to a hospital admission for that individual and ER visits not linked to an admission. RESULTS The authors find no significant effects of alcohol consumption on either ER visits or hospital admissions among older adults. These findings occur in both data sets, and for both men and women. Distinguishing between different types of ER visits makes no difference. DISCUSSION Analysis of two large and nationally representative data sets suggests that among older adults drinking alcohol, or even heavily drinking alcohol, does not raise or lower the risk of a hospital admission or the risk of an ER visit.
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Affiliation(s)
- Yong Li
- Competitive Health Analytics, Inc., Louisville, KY 40202, USA.
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Heise B. Healthcare system use by risky alcohol drinkers: A secondary data analysis. ACTA ACUST UNITED AC 2010; 22:256-63. [DOI: 10.1111/j.1745-7599.2010.00500.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Green CA, Polen MR, Leo MC, Janoff SL, Anderson BM, Weisner CM, Perrin NA. Drinking Patterns, Gender and Health III: Avoiding vs. Seeking Healthcare. ADDICTION RESEARCH & THEORY 2010; 18:160-180. [PMID: 23795149 PMCID: PMC3686530 DOI: 10.3109/16066350903398502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care. Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care. METHODS A stratified random sample of health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). We linked survey data to 24 months of health-plan records to examine relationships between alcohol use, gender, health-related attitudes, practices, health, and service use. In-depth interviews with a stratified 150-respondent subsample explored individuals' reasons for seeking or avoiding care. RESULTS Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher BMI, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care. CONCLUSIONS Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.
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Affiliation(s)
- Carla A. Green
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Michael R. Polen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Michael C. Leo
- Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Shannon L. Janoff
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
| | - Bradley M. Anderson
- Addiction Medicine Department, Interstate Medical Office East, Kaiser Permanente Northwest, 3550 N. Interstate Avenue, Portland, OR 97227, USA
| | - Constance M. Weisner
- University of California, San Francisco, 401 Parnassus Ave, Box F-0984, San Francisco, CA 94143 and Kaiser Permanente Division of Research, 2000 Broadway, 3rd floor, Oakland, CA 94612, USA
| | - Nancy A. Perrin
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, USA
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Jarl J, Gerdtham UG, Selin KH. Medical net cost of low alcohol consumption - a cause to reconsider improved health as the link between alcohol and wage? Cost Eff Resour Alloc 2009; 7:17. [PMID: 19852776 PMCID: PMC2770988 DOI: 10.1186/1478-7547-7-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 10/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have found a positive effect of low/moderate alcohol consumption on wages. This has often been explained by referring to epidemiological research showing that alcohol has protective effects on certain diseases, i.e., the health link is normally justified using selected epidemiological information. Few papers have tested this link between alcohol and health explicitly, including all diseases where alcohol has been shown to have either a protective or a detrimental effect. AIM Based on the full epidemiological information, we study the effect of low alcohol consumption on health, in order to determine if it is reasonable to explain the positive effect of low consumption on wages using the epidemiological literature. METHODS We apply a non-econometrical cost-of-illness approach to calculate the medical care cost and episodes attributable to low alcohol consumption. RESULTS Low alcohol consumption carries a net cost for medical care and there is a net benefit only for the oldest age group (80+). Low alcohol consumption also causes more episodes in medical care then what is saved, although inpatient care for women and older men show savings. CONCLUSION Using health as an explanation in the alcohol-wage literature appears invalid when applying the full epidemiological information instead of selected information.
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Affiliation(s)
- Johan Jarl
- Health Economics & Management, Institute of Economic Research, Lund University, Lund, Sweden.
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Balsa AI, French MT, Maclean JC, Norton EC. From pubs to scrubs: alcohol misuse and health care use. Health Serv Res 2009; 44:1480-503. [PMID: 19500163 DOI: 10.1111/j.1475-6773.2009.00987.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyze the relationships between alcohol misuse and two types of acute health care use-hospital admissions and emergency room (ER) episodes. DATA SOURCES/STUDY SETTING The first (2001/2002) and second (2004/2005) waves of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC). STUDY DESIGN Longitudinal study using a group of adults (18-60 years in Wave 1, N=23,079). Gender-stratified regression analysis adjusted for a range of covariates associated with health care use. First-difference methods corrected for potential omitted variable bias. DATA COLLECTION The target population of the NESARC was the civilian noninstitutionalized population aged 18 and older residing in the United States and the District of Columbia. The survey response rate was 81 percent in Wave 1 (N=43,093) and 65 percent in Wave 2 (N=34,653). PRINCIPAL FINDINGS Frequent drinking to intoxication was positively associated with hospital admissions for both men and women and increased the likelihood of using ER services for women. Alcohol dependence and/or abuse was related to higher use of ER services for both genders and increased hospitalizations for men. CONCLUSIONS These findings provide updated and nationally representative estimates of the relationships between alcohol misuse and health care use, and they underscore the potential implications of alcohol misuse on health care expenditures.
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Affiliation(s)
- Ana I Balsa
- Department of Sociology, Sociology Research Center, University of Miami, Coral Gables, FL, USA
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Bland PC, An L, Foldes SS, Garrett N, Alesci NL. Modifiable health behaviors and short-term medical costs among health plan members. Am J Health Promot 2009; 23:265-73. [PMID: 19288848 DOI: 10.4278/ajhp.08042842] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Describe the relationship among modifiable health behaviors and short-term medical costs. DESIGN Prospective study linking cross-sectional survey data that assessed modifiable risk behaviors with insurance claims. SETTING A large health plan in Minnesota. SUBJECTS A stratified, random sample of 10,000 yielded an analytic data set for 7983 members. MEASURES The dependent variable was per-member-per-month insurance payment plus subscriber liability. Eighteen months of medical costs were analyzed. Control variables included subscriber age, sex, type of insurance plan, days of enrollment, chronic disease status, education, and marital status. Independent variables, included self-reported health behaviors of smoking, heavy drinking, nutrition, and physical activity. ANALYSIS Linear regression was performed on the natural log of the cost variable, followed by a retransformation to dollars. RESULTS Physical inactivity and smoking were significant predictors of higher medical costs. Each day a member did not exercise there was a 2.9% difference in cost. Compared with never smokers, current smokers had 16% higher costs. Former smokers who had quit more than 1 year before taking the survey had 15% higher costs than never smokers. Recent former smokers cost 32% more than never smokers and more frequently experienced smoking-related medical conditions before they quit. Alcohol consumption was nonsignificant. Nutrition also was not significant but was narrowly measured by only fruit and vegetable consumption. CONCLUSION Physical inactivity and smoking were associated with higher short-term medical costs among health plan members.
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Affiliation(s)
- Patricia C Bland
- Blue Cross Blue Shield of Minnesota, Healthcare Informatics, Eagan, MN 55121, USA.
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Green CA, Polen MR, Janoff SL, Castleton DK, Perrin NA. "Not getting tanked": definitions of moderate drinking and their health implications. Drug Alcohol Depend 2007; 86:265-73. [PMID: 16930868 PMCID: PMC3536464 DOI: 10.1016/j.drugalcdep.2006.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 07/07/2006] [Accepted: 07/07/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND People encounter large amounts of sometimes-inconsistent information about risks and benefits of alcohol consumption, and about what constitutes "low-risk" or "moderate" drinking. METHODS We used 150 in-depth interviews linked to questionnaire data to learn how people define moderate drinking and to describe the relationships between definitions, attitudes, and beliefs about moderate drinking and individuals' drinking patterns. RESULTS People adhere to definitions of moderate alcohol consumption that could put them, or others, at risk for short- or long-term negative consequences of drinking. Definitions that confused increased tolerance of alcohol with moderate drinking, and those that defined moderate drinking by the absence of short-term negative consequences or ability to maintain control over drinking, ignore long-term risks of heavy consumption. Individuals with risky attitudes were also more likely to report at-risk drinking practices. CONCLUSIONS Americans have complex beliefs about benefits and risks of alcohol consumption, and public health officials have not succeeded in conveying strong or clear messages about what constitutes low-risk drinking or about dose-response effects. Different (but more consistent) approaches to public education may be needed to increase knowledge about drinking-related risks. The prevalence of diverse norm-based definitions suggests that alternative normative information could help people reassess their own consumption.
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Affiliation(s)
- Carla A. Green
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, 503.335.2479 phone, 503.335.2424 fax
| | - Michael R. Polen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, 503.335.6632 phone, 503.335.2424 fax
| | - Shannon L. Janoff
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, 503.335.6788 phone, 503.335.2424 fax
| | - David K. Castleton
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR 97227-1110, 503.335.6322 phone, 503.335.2424 fax
| | - Nancy A. Perrin
- School of Nursing, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098
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Baumeister SE, Schumann A, Nakazono TT, Alte D, Friedrich N, John U, Völzke H. Alcohol consumption and out-patient services utilization by abstainers and drinkers. Addiction 2006; 101:1285-91. [PMID: 16911727 DOI: 10.1111/j.1360-0443.2006.01538.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Previous studies have found that abstainers utilize out-patient health services more than alcohol consumers. The aim of this study was to investigate this relationship further by including several confounding variables and effect modifiers. It was hypothesized that abstainers utilize more health services because they have less social resources, practice more risky health behaviours, have poorer self-reported health and suffer more from chronic diseases. DESIGN AND PARTICIPANTS Cross-sectional health survey of a random sample of adults aged 20-64 in Pomerania, Germany. The response rate was 68.8%. Alcohol consumption was assessed using a quantity-frequency measure and categorized into past-year abstainers, low-risk, medium-risk and high-risk drinkers. Confounders and effect modifiers included socio-demographic and health-related variables. FINDINGS Abstainers had a 43% higher rate (rate ratio = 1.43, 95% CI = 1.24, 1.63) of physician visits compared to low-risk drinkers, adjusting for age and gender. Medium-risk and high-risk drinkers did not differ from low-risk drinkers in terms of out-patient visits. Further regression adjustment for socio-economic covariates, self-reported health status and chronic diseases suggested that abstainers used more out-patient services because they were more ill than drinkers. The effect of mental health status and the number of chronic diseases on out-patient visits was greater for abstainers than drinkers. CONCLUSIONS The relation between alcohol consumption and out-patient services is explained partly by poorer health among the abstainers. Further research is needed to affirm these results, such as transferring this evidence to the utilization of in-patient health services.
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Affiliation(s)
- Sebastian E Baumeister
- Medical School, Institute of Epidemiology and Social Medicine, University of Greifswald, Walther-Rathenau-Strasse 48, D-17487 Greifswald, Germany.
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Mertens JR, Weisner C, Ray GT, Fireman B, Walsh K. Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs. Alcohol Clin Exp Res 2005; 29:989-98. [PMID: 15976525 DOI: 10.1097/01.alc.0000167958.68586.3d] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There exists substantial evidence that individuals with alcohol and drug disorders have heightened comorbidities and health care costs. However, little is known about the larger population of "hazardous" drinkers (those whose consumption increases their "risk of physical and psychological harm") and drug users. METHODS A sample of 1,419 patients from HMO primary care clinics was screened for hazardous drinking and drug use. Health plan databases were used to examine medical conditions and health care costs of hazardous drinkers and drug users in the year prior to screening, in comparison to 13,347 patients from the same clinics, excluding those screened. RESULTS We found a prevalence of 7.5% for hazardous drinking and 3.2% for drug use in primary care (10% had at least one of the two problems). Hazardous drinkers and drug users had heightened prevalences for eight medical conditions, including costly conditions such as injury and hypertension, and psychiatric conditions. Medical costs for the year examined were not higher, except for those who also had psychiatric conditions. CONCLUSIONS The prevalence of hazardous drinking and drug use was similar to hypertension and diabetes. Hazardous drinkers and drug users' heightened medical conditions, especially those related to alcohol and drug abuse, indicate that screening and brief intervention at this lower threshold of hazardous drinking and drug use will detect individuals with health risks sooner. Optimal treatment and prevention of some medical disorders may require identification and intervention of underlying hazardous alcohol or drug use.
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Affiliation(s)
- Jennifer R Mertens
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA.
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Ford JD, Trestman RL, Tennen H, Allen S. Relationship of anxiety, depression and alcohol use disorders to persistent high utilization and potentially problematic under-utilization of primary medical care. Soc Sci Med 2005; 61:1618-25. [PMID: 16005791 DOI: 10.1016/j.socscimed.2005.03.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2004] [Accepted: 03/11/2005] [Indexed: 11/22/2022]
Abstract
Psychiatric disorders in primary medical care are prevalent, frequently undetected, under-treated, and costly. Studies report that psychiatric disorders are associated with high utilization of healthcare, but the stability of high utilization has not been systematically examined. Medical records data for 500 primary care patients in Connecticut, USA, representing high and modal utilization levels were examined over a 2-year period. In multi-variate analyses, only anxiety disorders were associated with persistent high utilization of primary care, as well as with inconsistent attendance. Alcohol use disorders were inversely associated with persistent high utilization, and positively related to inconsistent attendance and low complexity services (determined by evaluation and management coding). Depression was associated with low complexity primary care services and inconsistent attendance. Anxiety disorders and mixed anxiety-depression disorders warrant attention as potential contributors to persistent high or inconsistent utilization of primary healthcare. Alcohol use disorders may be under-treated in primary care due to inconsistent attendance, few visits, and low complexity services.
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Affiliation(s)
- Julian D Ford
- University of Connecticut School of Medicine Department of Psychiatry, MC1410, 263 Farmington Avenue, Farmington, CT 06030, USA.
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Zarkin GA, Bray JW, Babor TF, Higgins-Biddle JC. Alcohol drinking patterns and health care utilization in a managed care organization. Health Serv Res 2004; 39:553-70. [PMID: 15149478 PMCID: PMC1361024 DOI: 10.1111/j.1475-6773.2004.00244.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate the relationship between current drinking patterns and health care utilization over the previous two years in a managed care organization (MCO) among individuals who were screened for their alcohol use. STUDY DESIGN Three primary care clinics at a large western MCO administered a short health and lifestyle questionnaire to all adult patients on their first visit to the clinic from March 1998 through December 1998. Patients who exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for moderate drinking were given a more comprehensive alcohol screening using a modified version of the Alcohol Use Disorders Identification Test (AUDIT). Health care encounter data for two years preceding the screening visit were linked to the remaining individuals who responded to one or both instruments. Using both quantity-frequency and AUDIT-based drinking pattern variables, we estimated negative binomial models of the relationship between drinking patterns and days of health care use, controlling for demographic characteristics and other variables. PRINCIPAL FINDINGS For both the quantity-frequency and AUDIT-based drinking pattern variables, current alcohol use is generally associated with less health care utilization relative to abstainers. This relationship holds even for heavier drinkers, although the differences are not always statistically significant. With some exceptions, the overall trend is that more extensive drinking patterns are associated with lower health care use. CONCLUSIONS Based on our sample, we find little evidence that alcohol use is associated with increased health care utilization. On the contrary, we find that alcohol use is generally associated with decreased health care utilization regardless of drinking pattern.
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Affiliation(s)
- Gary A Zarkin
- RTI International, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA
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Abstract
BACKGROUND Despite established links among heavy alcohol consumption, other poor health behaviors, and poor health status, no Canadian study has specifically addressed the relationship between drinking and the use of preventive healthcare services. This study examines the relationship between drinking and female-specific preventive health service use through a secondary analysis of the 1996-1997 NPHS. METHODS Recent use of Pap smears and mammograms was examined in relation to current alcohol consumption, using multivariate logistic regression (weighted n = 25,095). RESULTS In general, there was a trend toward greater odds of recent service use among light and moderate drinkers than among heavy drinkers and lifetime abstainers. However, only moderate drinkers were significantly (P < 0.01) more likely than abstainers to have recently had a Pap smear. CONCLUSIONS The trend toward lower use of preventive services by heavy drinkers is concerning considering the established harmful effects of prolonged alcohol consumption on health and the tendency for multiple risk behaviors to cluster together in the same individuals. Early detection of departures from good health may alleviate the elevated use of healthcare services among those diagnosed with alcohol use disorders.
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Affiliation(s)
- Karen A Urbanoski
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Abstract
This paper compares the effects of obesity, overweight, smoking, and problem drinking on health care use and health status based on national survey data. Obesity has roughly the same association with chronic health conditions as does twenty years' aging; this greatly exceeds the associations of smoking or problem drinking. Utilization effects mirrors the health effects. Obesity is associated with a 36 percent increase in inpatient and outpatient spending and a 77 percent increase in medications, compared with a 21 percent increase in inpatient and outpatient spending and a 28 percent increase in medications for current smokers and smaller effects for problem drinkers. Nevertheless, the latter two groups have received more consistent attention in recent decades in clinical practice and public health policy.
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Affiliation(s)
- Roland Sturm
- Economic and Policy Research Program, UCLA/RAND Managed Care Center for Psychiatric Disorders, CA, USA
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Abstract
BACKGROUND Compared to abstention, moderate drinking has been linked to better health, and heavy and hazardous drinking to increased morbidity and mortality. Many studies have failed to account for heterogeneity in health and drinking history among nondrinkers, however. If former drinkers quit in response to ill health, this could increase the risk in the nondrinker category and underestimate the effects of alcohol if illnesses leading to abstention are alcohol-related. In addition, health behaviors may vary with drinking status, affecting health outcomes often attributed to drinking. METHODS Survey data were collected from a probability sample of a large health maintenance organization's membership. Regression analyses assess the relationship between drinking status (adjusting for covariates), mental and physical health and functioning, and health behaviors. RESULTS Former drinkers and lifelong abstainers had worse health and functioning than current drinkers and, comparatively, former drinkers had worse health than lifelong abstainers. Former drinkers did not differ from light-to-moderate drinkers in regard to health behaviors (except for smoking), although lifelong abstainers and heavier drinkers were less likely to use preventive care or try to improve their health behaviors. CONCLUSIONS Consistent with hypotheses that former drinkers may stop drinking because of poor health, former drinkers were less healthy than current drinkers and had slightly worse health than lifelong abstainers, compared to light-to-moderate drinkers. Former drinkers did not appear to be at risk because of poorer health behaviors (except smoking), but lifelong abstainers and heavier drinkers might benefit from outreach designed to increase use of preventive care and improve health behaviors.
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Affiliation(s)
- C A Green
- Center for Health Research, Kaiser Permanente, Portland, Oregon 97227-1110, USA.
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