Harmonization of alcohol use data and mortality across a multi‐national HIV cohort collaboration

Suzanne M Ingle; Adam J W Trickey; Anastasia Lankina; Kathleen McGinnis; Amy Justice; Matthias Cavassini; Antonella d'Arminio Monforte; Ard van Sighem; M John Gill; Heidi M Crane; Niels Obel; Inma Jarrin; Elmar  Wallner; Jodie Guest; Michael J Silverberg; Georgia Vourli; Linda Wittkop; Timothy R Sterling; Derek D Satre; Greer A Burkholder; Dominique Costagliola; Jonathan A C Sterne

doi:10.1111/acer.15522

Harmonization of alcohol use data and mortality across a multi‐national HIV cohort collaboration

Suzanne M Ingle^*, Adam J W Trickey, Anastasia Lankina, Kathleen McGinnis, Amy Justice, Matthias Cavassini, Antonella d'Arminio Monforte, Ard van Sighem, M John Gill, Heidi M Crane, Niels Obel, Inma Jarrin, Elmar Wallner, Jodie Guest, Michael J Silverberg, Georgia Vourli, Linda Wittkop, Timothy R Sterling, Derek D Satre, Greer A BurkholderDominique Costagliola, Jonathan A C Sterne

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

Abstract

Background
Alcohol use is measured in diverse ways across settings. Harmonization of measures is necessary to assess effects of alcohol use in multi-cohort collaborations, such as studies of people with HIV (PWH).

Methods
Data were combined from 14 HIV cohort studies (nine European, five North American) participating in the Antiretroviral Therapy Cohort Collaboration. We analyzed data on adult PWH with measured alcohol use at any time from 6 months before starting antiretroviral therapy. Five cohorts measured alcohol use with AUDIT-C and others used cohort-specific measures. We harmonized alcohol use as grams/day, calculated using country-level definitions of a standard drink. For Alcohol Use Disorders Identification Test (AUDIT-C), we used Items 1 (frequency) and 2 (number of drinks on a typical day). Where alcohol was measured in categories, we used the mid-point to calculate grams/day. We used multivariable Cox models to estimate associations of alcohol use with mortality.

Results
Alcohol use data were available for 83,424 PWH, 22,447 (27%) had AUDIT-C measures and 60,977 (73%) recorded the number of drinks/units per week/day. Of the sample, 19,150 (23%) were female, 54,006 (65%) had White ethnicity, and median age was 42 years. Median alcohol use was 0.3 g/day (interquartile range [IQR] 0–4.8) and 0 g/day (IQR 0–20) for those with and without AUDIT-C. There was a J-shaped relationship between grams/day and mortality, with higher mortality for PWH reporting no alcohol use (adjusted hazard ratio [aHR] 1.46; 95% CI: 1.23–1.72) and heavier (>61.0 g/day) alcohol use (aHR 1.92; 1.41–2.59) compared with 0.1–5.5 g/day among those with AUDIT-C measures. Associations were similar among those with non-AUDIT-C measures.

Conclusions
Grams/day is a useful metric to harmonize diverse measures of alcohol use. Magnitudes of associations of alcohol use with mortality may differ by setting and measurement method. Higher mortality among those with heavier alcohol use strengthens the case for interventions to reduce drinking.

Original language	English
Pages (from-to)	407-417
Number of pages	11
Journal	Alcohol, Clinical and Experimental Research
Volume	49
Issue number	2
Early online date	8 Jan 2025
DOIs	https://doi.org/10.1111/acer.15522
Publication status	Published - 14 Feb 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s). Alcohol, Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.

Keywords

epidemiology
alcohol
AUDIT‐C
harmonization
HIV

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Ingle, S. M., Trickey, A. J. W., Lankina, A., McGinnis, K., Justice, A., Cavassini, M., d'Arminio Monforte, A., van Sighem, A., Gill, M. J., Crane, H. M., Obel, N., Jarrin, I., Wallner, E., Guest, J., Silverberg, M. J., Vourli, G., Wittkop, L., Sterling, T. R., Satre, D. D., ... Sterne, J. A. C. (2025). Harmonization of alcohol use data and mortality across a multi‐national HIV cohort collaboration. Alcohol, Clinical and Experimental Research, 49(2), 407-417. https://doi.org/10.1111/acer.15522

@article{37e62ac354564ad087ed78995d61a567,

title = "Harmonization of alcohol use data and mortality across a multi‐national HIV cohort collaboration",

abstract = "BackgroundAlcohol use is measured in diverse ways across settings. Harmonization of measures is necessary to assess effects of alcohol use in multi-cohort collaborations, such as studies of people with HIV (PWH).MethodsData were combined from 14 HIV cohort studies (nine European, five North American) participating in the Antiretroviral Therapy Cohort Collaboration. We analyzed data on adult PWH with measured alcohol use at any time from 6 months before starting antiretroviral therapy. Five cohorts measured alcohol use with AUDIT-C and others used cohort-specific measures. We harmonized alcohol use as grams/day, calculated using country-level definitions of a standard drink. For Alcohol Use Disorders Identification Test (AUDIT-C), we used Items 1 (frequency) and 2 (number of drinks on a typical day). Where alcohol was measured in categories, we used the mid-point to calculate grams/day. We used multivariable Cox models to estimate associations of alcohol use with mortality.ResultsAlcohol use data were available for 83,424 PWH, 22,447 (27%) had AUDIT-C measures and 60,977 (73%) recorded the number of drinks/units per week/day. Of the sample, 19,150 (23%) were female, 54,006 (65%) had White ethnicity, and median age was 42 years. Median alcohol use was 0.3 g/day (interquartile range [IQR] 0–4.8) and 0 g/day (IQR 0–20) for those with and without AUDIT-C. There was a J-shaped relationship between grams/day and mortality, with higher mortality for PWH reporting no alcohol use (adjusted hazard ratio [aHR] 1.46; 95% CI: 1.23–1.72) and heavier (>61.0 g/day) alcohol use (aHR 1.92; 1.41–2.59) compared with 0.1–5.5 g/day among those with AUDIT-C measures. Associations were similar among those with non-AUDIT-C measures.ConclusionsGrams/day is a useful metric to harmonize diverse measures of alcohol use. Magnitudes of associations of alcohol use with mortality may differ by setting and measurement method. Higher mortality among those with heavier alcohol use strengthens the case for interventions to reduce drinking.",

keywords = "epidemiology, alcohol, AUDIT‐C, harmonization, HIV",

author = "Ingle, {Suzanne M} and Trickey, {Adam J W} and Anastasia Lankina and Kathleen McGinnis and Amy Justice and Matthias Cavassini and {d'Arminio Monforte}, Antonella and {van Sighem}, Ard and Gill, {M John} and Crane, {Heidi M} and Niels Obel and Inma Jarrin and Elmar Wallner and Jodie Guest and Silverberg, {Michael J} and Georgia Vourli and Linda Wittkop and Sterling, {Timothy R} and Satre, {Derek D} and Burkholder, {Greer A} and Dominique Costagliola and Sterne, {Jonathan A C}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Alcohol, Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.",

year = "2025",

month = feb,

day = "14",

doi = "10.1111/acer.15522",

language = "English",

volume = "49",

pages = "407--417",

journal = "Alcohol, Clinical and Experimental Research",

issn = "2993-7175",

publisher = "Wiley",

number = "2",

}

Ingle, SM , Trickey, AJW, Lankina, A, McGinnis, K, Justice, A, Cavassini, M, d'Arminio Monforte, A, van Sighem, A, Gill, MJ, Crane, HM, Obel, N, Jarrin, I, Wallner, E, Guest, J, Silverberg, MJ, Vourli, G, Wittkop, L, Sterling, TR, Satre, DD, Burkholder, GA, Costagliola, D & Sterne, JAC 2025, 'Harmonization of alcohol use data and mortality across a multi‐national HIV cohort collaboration', Alcohol, Clinical and Experimental Research, vol. 49, no. 2, pp. 407-417. https://doi.org/10.1111/acer.15522

TY - JOUR

T1 - Harmonization of alcohol use data and mortality across a multi‐national HIV cohort collaboration

AU - Ingle, Suzanne M

AU - Trickey, Adam J W

AU - Lankina, Anastasia

AU - McGinnis, Kathleen

AU - Justice, Amy

AU - Cavassini, Matthias

AU - d'Arminio Monforte, Antonella

AU - van Sighem, Ard

AU - Gill, M John

AU - Crane, Heidi M

AU - Obel, Niels

AU - Jarrin, Inma

AU - Wallner, Elmar

AU - Guest, Jodie

AU - Silverberg, Michael J

AU - Vourli, Georgia

AU - Wittkop, Linda

AU - Sterling, Timothy R

AU - Satre, Derek D

AU - Burkholder, Greer A

AU - Costagliola, Dominique

AU - Sterne, Jonathan A C

PY - 2025/2/14

Y1 - 2025/2/14

N2 - BackgroundAlcohol use is measured in diverse ways across settings. Harmonization of measures is necessary to assess effects of alcohol use in multi-cohort collaborations, such as studies of people with HIV (PWH).MethodsData were combined from 14 HIV cohort studies (nine European, five North American) participating in the Antiretroviral Therapy Cohort Collaboration. We analyzed data on adult PWH with measured alcohol use at any time from 6 months before starting antiretroviral therapy. Five cohorts measured alcohol use with AUDIT-C and others used cohort-specific measures. We harmonized alcohol use as grams/day, calculated using country-level definitions of a standard drink. For Alcohol Use Disorders Identification Test (AUDIT-C), we used Items 1 (frequency) and 2 (number of drinks on a typical day). Where alcohol was measured in categories, we used the mid-point to calculate grams/day. We used multivariable Cox models to estimate associations of alcohol use with mortality.ResultsAlcohol use data were available for 83,424 PWH, 22,447 (27%) had AUDIT-C measures and 60,977 (73%) recorded the number of drinks/units per week/day. Of the sample, 19,150 (23%) were female, 54,006 (65%) had White ethnicity, and median age was 42 years. Median alcohol use was 0.3 g/day (interquartile range [IQR] 0–4.8) and 0 g/day (IQR 0–20) for those with and without AUDIT-C. There was a J-shaped relationship between grams/day and mortality, with higher mortality for PWH reporting no alcohol use (adjusted hazard ratio [aHR] 1.46; 95% CI: 1.23–1.72) and heavier (>61.0 g/day) alcohol use (aHR 1.92; 1.41–2.59) compared with 0.1–5.5 g/day among those with AUDIT-C measures. Associations were similar among those with non-AUDIT-C measures.ConclusionsGrams/day is a useful metric to harmonize diverse measures of alcohol use. Magnitudes of associations of alcohol use with mortality may differ by setting and measurement method. Higher mortality among those with heavier alcohol use strengthens the case for interventions to reduce drinking.

AB - BackgroundAlcohol use is measured in diverse ways across settings. Harmonization of measures is necessary to assess effects of alcohol use in multi-cohort collaborations, such as studies of people with HIV (PWH).MethodsData were combined from 14 HIV cohort studies (nine European, five North American) participating in the Antiretroviral Therapy Cohort Collaboration. We analyzed data on adult PWH with measured alcohol use at any time from 6 months before starting antiretroviral therapy. Five cohorts measured alcohol use with AUDIT-C and others used cohort-specific measures. We harmonized alcohol use as grams/day, calculated using country-level definitions of a standard drink. For Alcohol Use Disorders Identification Test (AUDIT-C), we used Items 1 (frequency) and 2 (number of drinks on a typical day). Where alcohol was measured in categories, we used the mid-point to calculate grams/day. We used multivariable Cox models to estimate associations of alcohol use with mortality.ResultsAlcohol use data were available for 83,424 PWH, 22,447 (27%) had AUDIT-C measures and 60,977 (73%) recorded the number of drinks/units per week/day. Of the sample, 19,150 (23%) were female, 54,006 (65%) had White ethnicity, and median age was 42 years. Median alcohol use was 0.3 g/day (interquartile range [IQR] 0–4.8) and 0 g/day (IQR 0–20) for those with and without AUDIT-C. There was a J-shaped relationship between grams/day and mortality, with higher mortality for PWH reporting no alcohol use (adjusted hazard ratio [aHR] 1.46; 95% CI: 1.23–1.72) and heavier (>61.0 g/day) alcohol use (aHR 1.92; 1.41–2.59) compared with 0.1–5.5 g/day among those with AUDIT-C measures. Associations were similar among those with non-AUDIT-C measures.ConclusionsGrams/day is a useful metric to harmonize diverse measures of alcohol use. Magnitudes of associations of alcohol use with mortality may differ by setting and measurement method. Higher mortality among those with heavier alcohol use strengthens the case for interventions to reduce drinking.

KW - epidemiology

KW - alcohol

KW - AUDIT‐C

KW - harmonization

KW - HIV

U2 - 10.1111/acer.15522

DO - 10.1111/acer.15522

M3 - Article (Academic Journal)

C2 - 39779221

SN - 2993-7175

VL - 49

SP - 407

EP - 417

JO - Alcohol, Clinical and Experimental Research

JF - Alcohol, Clinical and Experimental Research

IS - 2

ER -

Harmonization of alcohol use data and mortality across a multi‐national HIV cohort collaboration

Abstract

Bibliographical note

Keywords

UN SDGs

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