TOPLINE:

The Alcohol Use Disorder Identification Test - Consumption (AUDIT-C) effectively predicted alcohol-attributable events (AAEs), with the risk increasing approximately exponentially per point scored. Optimal cutoff values for identifying individuals at risk differed by age and sex, with lower thresholds needed for older adults and women.

METHODOLOGY:

• Researchers analysed data from five nationwide Finnish general population health surveys conducted between 2011 and 2017, with follow-up through December 2023, totalling 879,964 person-years.
• A total of 95,477 adults aged 20 years or older (40,550 men and 54,927 women) without prior AAEs and with available AUDIT-C scores were included in the analysis.
• The AUDIT-C assessed the frequency of alcohol consumption, typical quantity per occasion, and frequency of consuming at least six drinks per occasion, with total scores ranging from 0 to 12 points.
• Outcome measures included incident AAEs (n = 1444) identified through wholly alcohol-attributable International Classification of Diseases, 10th Revision codes in health registers, death records, or prescription purchases for alcohol dependence medications.
• Cox proportional hazard models estimated hazard ratios (HRs) for associations between AUDIT-C scores and incident AAEs, with receiver operating characteristic curve analysis used to identify optimal cutoffs across age groups (20-64, 65-79, and ≥ 80 years) and sex.

TAKEAWAY:

• Each one-point increase in the AUDIT-C score was associated with a 49% higher hazard of AAEs overall (HR, 1.49; 95% CI, 1.45-1.53), with the increase being greater among women (HR, 1.61; 95% CI, 1.55-1.67) than among men (HR, 1.45; 95% CI, 1.40-1.49; P < .001 for the sex × AUDIT-C score interaction).
• The risk for AAEs was statistically significantly elevated at AUDIT-C scores of 2 points among women and 3 points among men compared with a reference score of 1 point.
• Older adults aged 65-79 years and 80 years or older had nearly twice the risk compared with those aged 20-64 years with the same sex and AUDIT-C score (65-79 years: HR, 1.86; 95% CI, 1.63-2.11; 80 years or older: HR, 1.86; 95% CI, 1.42-2.45).
• The area under the curve for predicting 5-year AAEs ranged from 74.8 to 83.2 across sex and age groups, demonstrating acceptable discrimination performance of the AUDIT-C.

IN PRACTICE:

"AUDIT-C predicted register-based alcohol-attributable events effectively, with the risk per point higher in women than men, but similar across working-aged and older adults. Optimal cut-offs may differ by age and sex, with lower thresholds for older adults and women. The population ≥ 65 years is heterogeneous, highlighting the need to consider whether uniform AUDIT-C cut-offs or lower-risk drinking guidelines are appropriate for all adults in this age group," the authors wrote.

"The selection of a cut-off and the balance between sensitivity and specificity should reflect the intended purpose of using AUDIT-C," they added.

SOURCE:

This study was led by Pia Mäkelä, Finnish Institute for Health and Welfare, Helsinki, Finland. It was published online on May 25, 2026, in Addiction.

LIMITATIONS:

The study was limited by the low number of events among participants aged 80 years or older, the single timepoint measurement of alcohol consumption, and the tracking of registry-based outcomes primarily reflecting more severe harms. Further constraints included the inability to account for individual-level factors such as comorbidities and medications and the application of a Finland-specific 12 g standard drink definition.

DISCLOSURES:

This study received support from the Päivikki and Sakari Sohlberg Foundation. One author disclosed receiving personal fees from dne Pharma, Otsuka, Lundbeck, Recordati, and Takeda, all unrelated to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.