But those with certain chronic conditions are more likely to have unhealthful alcohol use, Kaiser Permanente analysis finds
By Jan Greene
An analysis of 2.7 million Kaiser Permanente patients with one or more of 26 medical conditions finds that overall, they are less likely to drink alcohol heavily than people without those medical conditions.
However, the study also found higher risk of unhealthful drinking among people who drink alcohol and who have any of 4 conditions: chronic obstructive pulmonary disease (COPD), chronic liver disease, diabetes, and hypertension. The study was published May 13 in JAMA Network Open.
The findings are both heartening for physicians who care for sick people and a reminder that some patients may have higher risk of heavy alcohol use, said lead author Stacy Sterling, DrPH, MSW, research scientist at the Kaiser Permanente Division of Research.
“For people with important common chronic conditions, if they are drinking at unhealthy levels that can have some serious implications,” Sterling said. “It can disrupt their adherence to their treatment and medication regimens, their exercise and nutrition, and exacerbate symptoms. These are important things for clinicians to pay attention to.”
The authors analyzed medical records of Kaiser Permanente Northern California members who were screened for alcohol use in the previous 3 months during primary care visits between 2014 and 2017. The researchers used National Institute on Alcohol Abuse and Alcoholism drinking guidelines, which set a limit of no more than 4 daily drinks for men ages 18-65 and 3 daily drinks for all women and older men. The guidelines also set a weekly limit of no more than 14 drinks for men ages 18-65 and 7 drinks per week for all women and older men. The researchers defined unhealthy use as exceeding either daily or weekly limits.
Of a total 2.7 million patients screened, 1.86 million (68.3%) reported not drinking at all. This was a higher percentage than is typically found in population surveys and could be in part because patients under-reported their drinking to their doctors, Sterling said. However, the evidence-based way Kaiser Permanente asks patients about their alcohol use is likely to elicit an honest response, she said.
Patients with certain medical conditions might abstain from alcohol to avoid worsening their symptoms or to prevent side effects from medication, the authors said. Among the conditions studied that found no connection with unhealthful alcohol use were epilepsy, heart failure, rheumatoid arthritis, and cerebrovascular disease.
Compared with previous research, the authors said, this study had a larger sample size that was more diverse by gender, age, and ethnicity.
Coauthor Joseph Elson, MD, a San Francisco physician with The Permanente Medical Group, said the study illustrates the importance of an integrated, team-based approach to screening for unhealthy alcohol intake in the primary care setting. “These findings allow us to focus further attention on patients with COPD, liver disease, diabetes, and hypertension — all significant disease conditions that are sensitive to the effects of unhealthy alcohol usage.”
The study was funded by the National Institute on Alcohol Abuse and Alcoholism.
Coauthors included Constance Weisner, PhD, Felicia Chi, MPH, Vanessa A. Palzes, MPH, Yun Lu, MPH, Andrea H. Kline-Simon, MS, Sujaya Parthasarathy, PhD, and Clara Maxim of the Division of Research; and Thekla Ross, PsyD, of the Kaiser Permanente Care Management Institute.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 350 epidemiological and health services research projects.
For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.