Title

Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use: An individual patient data meta-analysis

Authors

Judith A. Hahn, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Pamela M. Murnane, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Eric Vittinghoff, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Winnie R. Muyindike, Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Nneka I. Emenyonu, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Robin Fatch, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Gabriel Chamie, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Jessica E. Haberer, Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
Joel M. Francis, National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania.
Saidi Kapiga, Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Karen Jacobson, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Bronwyn Myers, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.
Marie Claude Couture, University of San Francisco, San Francisco, CA, USA.
Ralph J. DiClemente, Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, USA.
Jennifer L. Brown, Department of Psychology and Psychiatry and Behavioral Neuroscience, Center for Addiction Research, University of Cincinnati, Cincinnati, OH, USA.
Kaku So-Armah, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Mark Sulkowski, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.

Document Type

Article

Publication Date

6-1-2021

Abstract

BACKGROUND: Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption. METHODS: We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1-step IPD meta-analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index-BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self-reported alcohol use using the AUDIT-C score. RESULTS: One third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables. CONCLUSIONS: Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.

Publication Source (Journal or Book title)

Alcoholism, clinical and experimental research

First Page

1166

Last Page

1187

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