일차진료에서 문제음주자 선별을 위한 Alcohol Use Disorders Identification Test Alcohol Consumption Questions (AUDIT-C)의 타당도 조사
Performance of the AUDIT Alcohol Consumption Questions (AUDIT-C) and AUDIT-K Question 3 Alone in Screening for Problem Drinking
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초록
연구배경: 문제음주를 선별하는 10문항 짜리 Alcohol Use Disorders Identifi cation Test in Korea (AUDIT-K)는 분주한 일차 진료현장에서 사용하기에 한계가 많다. 이에 AUDIT-K 선별 점수를 기준으로 AUDIT-K 1-3번 문항만을 묻는 AUDIT-C와 AUDIT-K 3번 단독문항의 문제음주 선별능력을 평가하고 두 선별도구의 절단점을 제시하여 일차진료에서 유용하게 사용 하고자 한다. 방법: 2007년 11월부터 2008년 4월까지 일개대학병원에 내원 한 음주력이 있는 남성 302명을 대상으로 AUDIT-K를 포함한 자가기입식 설문조사를 실시하였다. AUDIT-K 총점을 기준으 로 정상, 문제음주, 알코올사용장애, 알코올의존 4군으로 나눈 뒤, 각 음주행태별로 AUDIT-C와 3번 단독문항의 ROC곡선을 그려 적절한 민감도와 특이도를 보이는 절단점을 제시하였 다. 또한 area under the curve (AUC)를 통해 AUDIT-C와 3번 단 독문항의 문제음주 선별능력을 비교하였다. 결과: AUDIT-C의 경우, 8점 이상을 문제음주, 9점 이상을 알 코올사용장애, 11점 이상을 알코올 의존으로 선별할 때, 민감 도/특이도는 각각 82%/76%, 76%/79%, 80%/86%로 적절하였 다. 3번 단독문항의 경우, 3점 이상을 문제음주 혹은 알코올사 용장애, 4점을 알코올 의존으로 선별할 때 민감도/특이도는 각각 79%/80%, 84%/67%, 85%/77%로 적절하였다. 모든 음주 행태에 있어서 AUDIT-C가 3번 단독문항에 비해 우수한 선별 능력을 보였다(문제음주: 0.88 vs. 0.85, 알코올사용장애: 0.86 vs. 0.82, 알코올의존: 0.88 vs. 0.81). 결론: AUDIT-K에 비해 사용하기 간편한 AUDIT-C와 AUDITK 3번 단독문항은 문제음주 선별에 유용한 선별도구임을 확 인하였다. AUDIT-C 8점 이상, 또는 AUDIT-K 3번 단독문항 3 점 이상인 남성 음주자에게는 면밀한 음주평가와 적절한 중 재가 이루어져야 할 것이다.
Abstract
Background: In the busy primary care setting, there are several limitations in applying Alcohol Use Disorders Identifi cation Test in Korea (AUDIT-K) to screen problem drinking. Thus, for primary healthcare practice, we evaluated AUDIT-C, which covers questions from 1 to 3 in AUDIT-K, and AUDIT-K Question 3 Alone to present cut points for these two screening questionnaire according to AUDIT-K test scores. Methods: In a university hospital, we surveyed 302 males with a drinking history via self-administered questionnaire including AUDIT-K, from November 2007 to April 2008. On the basis of total score in AUDIT-K, we divided them into four groups: normal, problem drinking, alcohol use disorder, and alcohol dependence. For each alcohol drinking behavior pattern, we drew the receiver operating characteristics (ROC) curves to present cut points for appropriate sensitivity and specifi city. In addition, we compared the performance of AUDIT-C and AUDIT-K Question 3 Alone through area under the curve (AUC). Results: For AUDIT-C, we designated the score 8 or more as problem drinking, 9 or more as alcohol use disorder, and 11 or more as dependence. The results of sensitivity/specifi city for each group were 82%/76%, 76%/79%, 80%/86%, respectively, which were suitable for screening. For AUDIT-K Question 3 Alone, we defined the score 3 or more as problem drinking or alcohol use disorder and the score 4 as dependence. The results of sensitivity/specifi city for each group were 79%/80%, 84%/67%, 85%/77%, which were appropriate for screening. For every drinking behavior group, AUDIT-C was superior to AUDIT-K Question 3 Alone in screening performance (problem drinking: 0.88 vs. respectively 0.85, alcohol use disorder: 0.86 vs. 0.82, alcohol dependence: 0.88 vs. 0.81) Conclusion: We confi rmed that both AUDIT-C and AUDIT-K Question 3 Alone, which are more convenient and have fewer time con-straints than AUDIT-K, are reasonable screening methods for problem drinking. Thus, we recommend further drinking assessment and proper intervention for male drinkers who have scores 8 or more in AUDIT-C or 3 or more in AUDIT-K Question 3 Alone.
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