Project description:Background & aimsBariatric surgery is common, but alcohol misuse has been reported following these procedures. We aimed to determine if bariatric surgery is associated with increased risk of alcohol-related cirrhosis (AC) and alcohol misuse.MethodsRetrospective observational analysis of obese adults with employer-sponsored insurance administrative claims from 2008 to 2016. Subjects with diagnosis codes for bariatric surgery were included. Primary outcome was risk of AC. Secondary outcome was risk of alcohol misuse. Bariatric surgery was divided into before 2008 and after 2008 to account for patients who had a procedure during the study period. Cox proportional hazard regression models using age as the time variable were used with interaction analyses for bariatric surgery and gender.ResultsA total of 194 130 had surgery from 2008 to 2016 while 209 090 patients had bariatric surgery prior to 2008. Age was 44.1 years, 61% women and enrolment was 3.7 years. A total of 4774 (0.07%) had AC. Overall risk of AC was lower for those who received sleeve gastrectomy and laparoscopic banding during the study period (HR 0.4, P <.001; HR 0.43, P =.02) and alcohol misuse increased for Roux-en-Y and sleeve gastrectomy recipients (HR 1.86 and 1.35, P <.001, respectively). In those who had surgery before 2008, women had increased risk of AC and alcohol misuse compared to women without bariatric surgery (HR 2.1 [95% CI: 1.79-2.41] for AC; HR 1.98 [95% CI 1.93-2.04]).ConclusionsBariatric surgery is associated with a short-term decreased risk of AC but potential long-term increased risk of AC in women. Post-operative alcohol surveillance is necessary to reduce this risk.
Project description:Alcohol misuse during adolescence (AAM) has been associated with disruptive development of adolescent brains. In this longitudinal machine learning (ML) study, we could predict AAM significantly from brain structure (T1-weighted imaging and DTI) with accuracies of 73 -78% in the IMAGEN dataset (n∼1182). Our results not only show that structural differences in brain can predict AAM, but also suggests that such differences might precede AAM behavior in the data. We predicted 10 phenotypes of AAM at age 22 using brain MRI features at ages 14, 19, and 22. Binge drinking was found to be the most predictable phenotype. The most informative brain features were located in the ventricular CSF, and in white matter tracts of the corpus callosum, internal capsule, and brain stem. In the cortex, they were spread across the occipital, frontal, and temporal lobes and in the cingulate cortex. We also experimented with four different ML models and several confound control techniques. Support Vector Machine (SVM) with rbf kernel and Gradient Boosting consistently performed better than the linear models, linear SVM and Logistic Regression. Our study also demonstrates how the choice of the predicted phenotype, ML model, and confound correction technique are all crucial decisions in an explorative ML study analyzing psychiatric disorders with small effect sizes such as AAM.
Project description:BackgroundEarly midlife individuals (ages 30-40) experience demographic shifts that may influence the remainder of adult life. Although new or persistent alcohol misuse is common during this period, early midlife is understudied in alcohol use literature. We examined the heritability of alcohol misuse; the associations between alcohol misuse and sociodemographic factors, physical health, and well-being; and whether these associations were robust in cotwin comparisons.MethodsParticipants were 1446 Finnish twin pairs and 748 nonpaired Finnish twins with mean age 34 years. The alcohol misuse index was a composite measure of frequency of use, intoxication, heavy episodic drinking, and alcohol problems assessed with the Malmö-modified Michigan Alcoholism Screening Test and the Rutgers Alcohol Problem Index. Early midlife correlates included relationship status and length, family formation, unemployment status, education level, self-rated health, pain, sleeping difficulties, life satisfaction, psychological health, and other substance use. We employed a sex-limitation model to estimate early midlife heritability. Linear and fixed effects regression models were used for individual and cotwin comparison analyses, respectively.ResultsAdditive genetic (A) and unique environmental (E) components of alcohol misuse variance differed across sex (Females: A = 62%, E = 38%; Males: A = 49%, E = 51%). In individual-based analyses, higher scores on the alcohol misuse index were associated with lower relationship stability, financial situation, education level, self-rated health, physical fitness, life satisfaction and psychological health, and higher self-reported pain, sleep difficulties, unemployment rates and other substance use (R2 = 0.008-0.12). Associations remained significant in cotwin comparison analyses (R2 = 0.004-0.10) except for financial situation and education level.ConclusionsThere is evidence of sex differences in the etiological factors that influence early midlife drinking. After controlling for confounding familial factors, associations between alcohol misuse and poorer early midlife functioning largely remained, suggesting that alcohol misuse may play a role in poorer functioning across several outcomes.
Project description:BackgroundCurrent modes of identifying alcohol misuse in hospitalized patients rely on self-report questionnaires and diagnostic codes that have limitations, including low sensitivity. Information in the clinical notes of the electronic health record (EHR) may further augment the identification of alcohol misuse. Natural language processing (NLP) with supervised machine learning has been successful at analyzing clinical notes and identifying cases of alcohol misuse in trauma patients.MethodsAn alcohol misuse NLP classifier, previously developed on trauma patients who completed the Alcohol Use Disorders Identification Test, was validated in a cohort of 1000 hospitalized patients at a large, tertiary health system between January 1, 2007 and September 1, 2017. The clinical notes were processed using the clinical Text Analysis and Knowledge Extraction System. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for alcohol misuse were used during annotation of the medical records in our validation dataset.ResultsThe alcohol misuse classifier had an area under the receiver operating characteristic curve of 0.91 (95% CI 0.90-0.93) in the cohort of hospitalized patients. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.88 (95% CI 0.85-0.90), 0.78 (95% CI 0.74-0.82), 0.85 (95% CI 0.82-0.87), and 0.82 (95% CI 0.78-0.86), respectively. The Hosmer-Lemeshow Test (p = 0.13) demonstrates good model fit. Additionally, there was a dose-dependent response in alcohol consumption behaviors across increasing strata of predicted probabilities for alcohol misuse.ConclusionThe alcohol misuse NLP classifier had good discrimination and test characteristics in hospitalized patients. An approach using the clinical notes with NLP and supervised machine learning may better identify alcohol misuse cases than conventional methods solely relying on billing diagnostic codes.
Project description:PurposeTo investigate the role of consumption phenotypes as genetic proxies for alcohol misuse and nicotine dependence.MethodsWe leveraged GWAS data from well-powered studies of consumption, alcohol misuse, and nicotine dependence phenotypes measured in individuals of European ancestry from the UK Biobank (UKB) and other population-based cohorts (largest total N = 263,954), and performed genetic correlations within a medical-center cohort, BioVU (N = 66,915). For alcohol, we used quantitative measures of consumption and misuse via AUDIT from UKB. For smoking, we used cigarettes per day from UKB and non-UKB cohorts comprising the GSCAN consortium, and nicotine dependence via ICD codes from UKB and Fagerström Test for Nicotine Dependence from non-UKB cohorts.ResultsIn a large phenome-wide association study, we show that smoking consumption and dependence phenotypes show similar strongly negatively associations with a plethora of diseases, whereas alcohol consumption shows patterns of genetic association that diverge from those of alcohol misuse.ConclusionsOur study suggests that cigarette smoking consumption, which can be easily measured in the general population, may be good a genetic proxy for nicotine dependence, whereas alcohol consumption is not a direct genetic proxy of alcohol misuse.
Project description:To analyze the relationships between alcohol misuse and two types of acute health care use-hospital admissions and emergency room (ER) episodes.The first (2001/2002) and second (2004/2005) waves of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC).Longitudinal study using a group of adults (18-60 years in Wave 1, N=23,079). Gender-stratified regression analysis adjusted for a range of covariates associated with health care use. First-difference methods corrected for potential omitted variable bias.The target population of the NESARC was the civilian noninstitutionalized population aged 18 and older residing in the United States and the District of Columbia. The survey response rate was 81 percent in Wave 1 (N=43,093) and 65 percent in Wave 2 (N=34,653).Frequent drinking to intoxication was positively associated with hospital admissions for both men and women and increased the likelihood of using ER services for women. Alcohol dependence and/or abuse was related to higher use of ER services for both genders and increased hospitalizations for men.These findings provide updated and nationally representative estimates of the relationships between alcohol misuse and health care use, and they underscore the potential implications of alcohol misuse on health care expenditures.
Project description:Background and aimsPrevious twin research suggests relationship status can moderate underlying genetic liability towards alcohol misuse. This paper examined: (1) whether genome-wide polygenic scores (GPS) for alcohol consumption are associated with alcohol misuse; (2) whether these GPS are moderated by romantic relationships (gene-environment interaction; G × E) and (3) whether G × E results are consistent across sex.DesignLinear mixed-effects models were used to test associations between genome-wide polygenic scores, relationship status and alcohol use/misuse.SettingFinnish twins born between 1983 and 1987 identified through Finland's central population registry.ParticipantsAn intensively studied subset of Finnish Twin Study (FinnTwin12) during the young adult phase (aged 20-26 years). The analytical sample includes those with complete interview and genetic data (n = 1201).MeasurementsKey measurements included involvement in a romantic partnership, drinking frequency, intoxication frequency and DSM-IV alcohol dependence (AD) symptoms. Genome-wide polygenic scores (GPS) were created from available summary statistics from a large genome-wide association study (GWAS) of drinks per week.ResultsGPS predicted drinking frequency [b = 0.109; 95% confidence interval (CI) = 0.050, 0.168], intoxication frequency (b = 0.111; 95% CI = 0.054, 0.168) and AD symptoms (b = 0.123; 95% CI = 0.064, 0.182). Having a romantic relationship negatively influenced the association between GPS and drinking frequency (b = -0.105; 95% CI = -0.211, -0.001), intoxication frequency (b = -0.118; 95% CI = -0.220, -0.016) and AD symptoms (b = -0.119; 95% CI = -0.229, -0.009). There was a three-way interaction between sex, relationship status and GPS for intoxication frequency (b = 0.223; 95% CI = 0.013, 0.433), such that the reduced association between GPS and intoxication frequency for those in a relationship was only apparent in males. We found no evidence of three-way interactions for drinking frequency or AD symptoms.ConclusionsBeing in a romantic relationship reduced the association between genetic predisposition and drinking, high-risk drinking and alcohol problems. However, for high-risk drinking the protective effect was limited to males, mapping onto earlier findings suggesting that males benefit more from romantic partnerships.
Project description:Alcohol-related research in Botswana has rarely used a socio-ecological approach. This article presents a phenomenological in-depth analysis drawn from community mapping interviews (n = 23) collected among community leaders and service providers in one village in Botswana. The socio-ecological approach guided our research and analysis. This paper explored the influence of alcohol misuse within the cultural, familial, practices and legal frameworks in Botswana. Findings revealed patterns in alcohol misuse over time, the influence of alcohol misuse within different ecological systems, and their response to alcohol patterns as three global themes are discussed. The findings showed that alcohol misuse remains a major public health problem that trickles down from the community, and family systems to an individual, when there are with limited resources to address the alcohol misuse that exists. Recommendations to address alcohol misuse in Botswana include providing alcohol-free recreational places, more research on alcohol harm, and educating communities about alcohol harm.
Project description:BackgroundAlcohol use typically begins during adolescence and escalates into young adulthood. This represents an important period for the establishment of alcohol use and misuse patterns, which can have psychosocial and medical consequences. Although changes in alcohol use during this time have been phenotypically characterized, their genetic nature is poorly understood.MethodsParticipants of the Avon Longitudinal Study of Parents and Children completed the Alcohol Use Disorders Identification Test (AUDIT) 4 times from age 16 to 20. We used Mplus to construct a growth model characterizing changes in AUDIT scores across time (N = 4,545, where data were available for at least 2 time points). The slope of the model was used as the phenotype in a genomewide association study (N = 3,380), followed by secondary genetic analyses.ResultsNo individual marker met genomewide significance criteria. Top markers mapped to biologically plausible candidate genes. The slope term was moderately heritable (h2SNP = 0.26, p = 0.009), and replication attempts using a meta-analysis of independent samples provided support for implicated variants at the aggregate level. Nominally significant (p < 0.00001) markers mapped to putatively active genomic regions in brain tissue more frequently than expected by chance.ConclusionsThese results build on prior studies by demonstrating that common genetic variation impacts alcohol misuse trajectories. Influential loci map to genes that merit additional research, as well as to intergenic regions with regulatory functions in the central nervous system. These findings underscore the complex biological nature of alcohol misuse across development.