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An empirical approach to evaluating the validity of alternative low-risk drinking guidelines.

ABSTRACT: INTRODUCTION AND AIMS:This paper proposes an approach for evaluating the validity of alternative low-risk drinking guidelines. DESIGN AND METHODS:Twenty-seven alternative guidelines were evaluated in terms of their ability to predict nine measures of concurrent and prospective alcohol-related harm, using longitudinal data from a nationally representative sample of US adults (n?=?26?438 to 12?339 depending upon outcome). Parameters compared included sensitivity, specificity, adjusted odds ratios and measures of model fit. RESULTS:Performance varied by harm. The guidelines that best predicted concurrent alcohol-related harm comprised daily-only limits of 4/3 drinks for men/women, but gender-invariant limits of 4/4 drinks also performed well. Adding weekly limits did little to improve the prediction of concurrent harm. The guidelines that best predicted prospective harm comprised daily limits of 4/4 drinks combined with weekly limits of 14 drinks for men and 7 drinks for women, with weekly limits of 14/14 drinks running second. When concurrent and incident harms were aggregated, daily-only limits of 4/3 drinks performed nearly on a par with the combination of 14/14 drinks per week and 4/3 drinks per day. DISCUSSION AND CONCLUSIONS:This paper supported gender-specific daily limits and suggested that optimal guidelines might take daily limits from analyses of concurrent harms and weekly limits from analyses of prospective harms. This paper illustrates a mechanism for validating the ability of low-risk drinking guidelines to accurately predict a range of alcohol-related harms, whereby countries could use their own data on consumption and its association with harm to evaluate their low-risk drinking guidelines

SUBMITTER: Dawson DA

PROVIDER: S-EPMC3252404 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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An empirical approach to evaluating the validity of alternative low-risk drinking guidelines.

Dawson Deborah A DA Smith Sharon M SM Pickering Roger P RP Grant Bridget F BF

Drug and alcohol review 20110929 2

<h4>Introduction and aims</h4>This paper proposes an approach for evaluating the validity of alternative low-risk drinking guidelines.<h4>Design and methods</h4>Twenty-seven alternative guidelines were evaluated in terms of their ability to predict nine measures of concurrent and prospective alcohol-related harm, using longitudinal data from a nationally representative sample of US adults (n = 26 438 to 12 339 depending upon outcome). Parameters compared included sensitivity, specificity, adjust ...[more]

PMID: 21954858

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Project description:BackgroundMulti-attribute utility measures are preference-based health-related quality of life measures that have been developed to inform economic evaluations of health care interventions. The objective of this study was to compare the empirical validity of two multi-attribute utility measures (EQ-5D and SF-6D) based on hypothetical preferences in a large maternity population in England.MethodsWomen who participated in a randomised controlled trial of additional postnatal support provided by trained community support workers represented the study population for this investigation. The women were asked to complete the EQ-5D descriptive system (which defines health-related quality of life in terms of five dimensions: mobility, self care, usual activities, pain/discomfort and anxiety/depression) and the SF-36 (which defines health-related quality of life, using 36 items, across eight dimensions: physical functioning, role limitations (physical), social functioning, bodily pain, general health, mental health, vitality and role limitations (emotional)) at six months postpartum. Their responses were converted into utility scores using the York A1 tariff set and the SF-6D utility algorithm, respectively. One-way analysis of variance was used to test the hypothetically-constructed preference rule that each set of utility scores differs significantly by self-reported health status (categorised as excellent, very good, good, fair or poor). The degree to which EQ-5D and SF-6D utility scores reflected alternative dichotomous configurations of self-reported health status and the Edinburgh Postnatal Depression Scale score was tested using the relative efficiency statistic and receiver operating characteristic (ROC) curves.ResultsThe mean utility score for the EQ-5D was 0.861 (95% CI: 0.844, 0.877), whilst the mean utility score for the SF-6D was 0.809 (95% CI: 0.796, 0.822), representing a mean difference in utility score of 0.052 (95% CI: 0.040, 0.064; p < 0.001). Both measures demonstrated statistically significant differences between subjects who described their health status as excellent, very good, good, fair or poor (p < 0.001), as well as monotonically decreasing utility scores (test for linear trend: p < 0.001). The SF-6D was between 29.1% and 423.6% more efficient than the EQ-5D at detecting differences in self-reported health status, and between 129.8% and 161.7% more efficient at detecting differences in the Edinburgh Postnatal Depression Scale score. In addition, the SF-6D generated higher area under the curve (AUC) scores generated by the ROC curves than the EQ-5D, indicating greater discriminatory power, although in all but one analysis the differences in AUC scores between the measures were not statistically significant.ConclusionThis study provides evidence that the SF-6D is an empirically valid and efficient alternative multi-attribute utility measure to the EQ-5D, and is capable of discriminating between external indicators of maternal health.

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An empirical approach to evaluating the validity of alternative low-risk drinking guidelines.

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An empirical approach to evaluating the validity of alternative low-risk drinking guidelines.

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