Development and Validation of a Risk Model for Prediction of Hazardous Alcohol Consumption in General Practice Attendees: The PredictAL Study
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AuthorKing, Michael; Marston, Louise; Švab, Igor; Maaroos, Heidi-Ingrid; Geerlings, Mirjam I.; Xavier, Miguel; Vicente, Benjamín; Torres González, Francisco; Bellón Saameño, Juan Ángel; Rotar, Danica; Aluoja, Anu; Saldivia, Sandra; Correa, Bernardo; Nazareth, Irwin
Public Library of Science (PLOS)
Alcohol consumptionAlcoholsDepressionEuropeForecastingMental health and psychiatryNetherlandsPrimary care
King, M.; et al. Development and Validation of a Risk Model for Prediction of Hazardous Alcohol Consumption in General Practice Attendees: The PredictAL Study. Plos One, 6(8): e22175 (2011). [http://hdl.handle.net/10481/31066]
SponsorshipThe study in Europe was funded by a European Commission Vth Framework grant (PREDICT-QL4-CT2002-00683). Funding in Chile was provided by project FONDEF DO2I-1140. The authors are grateful for part support in Europe from: the Estonian Scientific Foundation (grant 5696); the Slovenian Ministry for Research (grant 4369-1027); the Spanish Ministry of Health (FIS references: PI041980, PI041771, PI042450) and the Spanish Network of Primary Care Research, red de Investigacion en Actividades Preventivas y Promocion de la salud (ISCIII-RETIC RD06/0018) and SAMSERAP group, and the United Kingdom National Health Service Research and Development office for service support costs in the United Kingdom.
[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.