Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups
The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear.
To evaluate the validity of the AUDIT-C among primary care patients from the predominant racial/ethnic subgroups within the United States: White, African American, and Hispanic.
Cross-sectional interview validation study.
1,292 outpatients from an academic family practice clinic in Texas (90% of randomly sampled eligible).
Measurements and Main Results
Race/ethnicity was self-reported. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. AUDIT-C sensitivities and specificities at recommended screening thresholds were compared across racial/ethnic groups. AuROCs were greater than 0.85 in all 3 groups, with no significant differences across racial/ethnic groups in men (P = .43) or women (P = .12). At previously recommended cut points, there were statistically significant differences by race in AUDIT-C sensitivities but not specificities. In women, the sensitivity was higher in Hispanic (85%) than in African-American (67%; P = .03) or White (70%; P = .04) women. In men, the sensitivity was higher in White (95%) than in African-American men (76%; P = .01), with no significant difference from Hispanic men (85%; P = .11).
The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there were significant differences in the AUDIT-C’s sensitivity but not in specificity across the 3 racial/ethnic groups.
Key Wordsalcohol alcohol misuse race ethnicity screening diagnostic test
The authors would like to acknowledge Colin Cooke for his thoughtful review of the manuscript.
Sources of Funding
The research reported here was supported by Health Service Research and Development (HSR&D) MD Postdoctoral Fellowship Research TPM 61-028 and the National Institute on Alcohol Abuse and Alcoholism R21AA14672. Dr. Frank is a senior general medicine fellow at the VA Northwest HSR&D Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, or the NIAAA.
Conflict of Interest
The authors have no potential conflicts of interest that pertain to the content of this manuscript.
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