Research Article: Risk of future trauma based on alcohol screening scores: A two-year prospective cohort study among US veterans

Date Published: April 30, 2012

Publisher: BioMed Central

Author(s): Alex H S Harris, Anna Lembke, Patricia Henderson, Shalini Gupta, Rudolf Moos, Katharine A Bradley.


Severe alcohol misuse as measured by the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) is associated with increased risk of future fractures and trauma-related hospitalizations. This study examined the association between AUDIT-C scores and two-year risk of any type of trauma among US Veterans Health Administration (VHA) patients and assessed whether risk varied by age or gender.

Outpatients (215, 924 male and 9168 female) who returned mailed AUDIT-C questionnaires were followed for 24 months in the medical record for any International Statistical Classification of Diseases and Related Health Problems (ICD-9) code related to trauma. The two-year prevalence of trauma was examined as a function of AUDIT-C scores, with low-level drinking (AUDIT-C 1–4) as the reference group. Men and women were examined separately, and age-stratified analyses were performed.

Having an AUDIT-C score of 9–12 (indicating severe alcohol misuse) was associated with increased risk for trauma. Mean (SD) ages for men and women were 68.2 (11.5) and 57.2 (15.8), respectively. Age-stratified analyses showed that, for men ≤50 years, those with AUDIT-C scores ≥9 had an increased risk for trauma compared with those with AUDIT-C scores in the 1–4 range (adjusted prevalence, 25.7% versus 20.8%, respectively; OR = 1.24; 95% confidence interval [CI], 1.03–1.50). For men ≥65 years with average comorbidity and education, those with AUDIT-C scores of 5–8 (adjusted prevalence, 7.9% versus 7.4%; OR = 1.16; 95% CI, 1.02–1.31) and 9–12 (adjusted prevalence 11.1% versus 7.4%; OR = 1.68; 95% CI, 1.30–2.17) were at significantly increased risk for trauma compared with men ≥65 years in the reference group. Higher AUDIT-C scores were not associated with increased risk of trauma among women.

Men with severe alcohol misuse (AUDIT-C 9–12) demonstrate an increased risk of trauma. Men ≥65 showed an increased risk for trauma at all levels of alcohol misuse (AUDIT-C 5–8 and 9–12). These findings may be used as part of an evidence-based brief intervention for alcohol use disorders. More research is needed to understand the relationship between AUDIT-C scores and risk of trauma in women.

Partial Text

Trauma is the leading cause of death in the United States in persons aged ≤44 years, and alcohol misuse is linked to higher risk of traumatic injury [1]. Alcohol is a factor in 60% of fatal burns, 40% of motor vehicle accidents with serious injury, and 42% of pedestrian fatalities [2]. In one study of 1118 adult patients admitted to trauma centers, 54% had a lifetime history of a substance use disorder, and 24% had a current diagnosis of alcohol dependence [3]. The annual cost of alcohol-related motor-vehicle accidents alone is US $51 billion [2].

To our knowledge, this is the first study to examine the relationship between alcohol screening scores (AUDIT-C) and risk of inpatient, residential, and outpatient medical treatment for any type of trauma. This is also one of few studies to look at women’s trauma risk separate from men’s. In male VHA patients, severe alcohol misuse (AUDIT-C 9–12) was associated with a significantly increased risk for trauma, particularly fractures. Men in the oldest age group (>65 years) showed increased risk of medical care for trauma even at lower levels of alcohol misuse (AUDIT C 5–8). These findings augment prior research, which found an association between severe alcohol misuse and specific risk of fracture [17], and between severe alcohol misuse and trauma-related hospitalization [18].

The authors declare that they have no competing interests.

AH conceived of the study, supervised the acquisition and analysis of data, and helped draft the manuscript. AL drafted the manuscript and assisted in the interpretation of the data. PH and SG led the statistical analyses. RM and KB helped conceive the study, helped with interpretation of the data, and helped draft the manuscript. All authors read and approved the final manuscript.