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Development and Validation of a Risk Model for Prediction of Hazardous Alcohol Consumption in General Practice Attendees: The PredictAL Study

Author

Listed:
  • Michael King
  • Louise Marston
  • Igor Švab
  • Heidi-Ingrid Maaroos
  • Mirjam I Geerlings
  • Miguel Xavier
  • Vicente Benjamin
  • Francisco Torres-Gonzalez
  • Juan Angel Bellon-Saameno
  • Danica Rotar
  • Anu Aluoja
  • Sandra Saldivia
  • Bernardo Correa
  • Irwin Nazareth

Abstract

Background: Little is known about the risk of progression to hazardous alcohol use in people currently drinking at safe limits. We aimed to develop a prediction model (predictAL) for the development of hazardous drinking in safe drinkers. Methods: A prospective cohort study of adult general practice attendees in six European countries and Chile followed up over 6 months. We recruited 10,045 attendees between April 2003 to February 2005. 6193 European and 2462 Chilean attendees recorded AUDIT scores below 8 in men and 5 in women at recruitment and were used in modelling risk. 38 risk factors were measured to construct a risk model for the development of hazardous drinking using stepwise logistic regression. The model was corrected for over fitting and tested in an external population. The main outcome was hazardous drinking defined by an AUDIT score ≥8 in men and ≥5 in women. Results: 69.0% of attendees were recruited, of whom 89.5% participated again after six months. The risk factors in the final predictAL model were sex, age, country, baseline AUDIT score, panic syndrome and lifetime alcohol problem. The predictAL model's average c-index across all six European countries was 0.839 (95% CI 0.805, 0.873). The Hedge's g effect size for the difference in log odds of predicted probability between safe drinkers in Europe who subsequently developed hazardous alcohol use and those who did not was 1.38 (95% CI 1.25, 1.51). External validation of the algorithm in Chilean safe drinkers resulted in a c-index of 0.781 (95% CI 0.717, 0.846) and Hedge's g of 0.68 (95% CI 0.57, 0.78). Conclusions: The predictAL risk model for development of hazardous consumption in safe drinkers compares favourably with risk algorithms for disorders in other medical settings and can be a useful first step in prevention of alcohol misuse.

Suggested Citation

  • Michael King & Louise Marston & Igor Švab & Heidi-Ingrid Maaroos & Mirjam I Geerlings & Miguel Xavier & Vicente Benjamin & Francisco Torres-Gonzalez & Juan Angel Bellon-Saameno & Danica Rotar & Anu Al, 2011. "Development and Validation of a Risk Model for Prediction of Hazardous Alcohol Consumption in General Practice Attendees: The PredictAL Study," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-10, August.
  • Handle: RePEc:plo:pone00:0022175
    DOI: 10.1371/journal.pone.0022175
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    References listed on IDEAS

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    3. Margaret Pepe & Holly Janes & Gary Longton & Wendy Leisenring & Polly Newcomb, 2004. "Limitations of the Odds Ratio in Gauging the Performance of a Diagnostic or Prognostic Marker," UW Biostatistics Working Paper Series 1035, Berkeley Electronic Press.
    4. Patrick Royston, 2005. "MICE for multiple imputation of missing values," United Kingdom Stata Users' Group Meetings 2005 02, Stata Users Group.
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