Subjective measures of binge drinking and alcohol-specific adverse health outcomes: a prospective cohort study.

Aim: To determine the performance of subjectively defined intoxications, hangovers and alcohol-induced pass-outs in identifying drinkers at risk for adverse health outcomes.

Design: Prospective population-based cohort study.

Setting: Working-aged Finnish general population.

Participants: A total of 21,204 alcohol-drinking men and women aged 20-24, 30-34, 40-44 and 50-54 years at baseline who participated in the Health and Social Support (HeSSup) postal survey in 1998.

Measurements: Binge drinking was measured by subjectively defined intoxications/drunkenness, hangovers and alcohol-induced pass-outs. Hazardous drinking was defined according to Finnish guidelines as weekly total intake of >287 g of ethanol for men, and for women > 191 g of ethanol (≥24 and ≥16 standard drinks, respectively). Study participants were followed-up for 7 years for alcohol-specific hospitalizations and deaths. Proportional hazard models and areas under the receiver operating characteristics curves (AUC) were used to analyse the data.

Findings: Of the drinkers, 6.5% exceeded the weekly limit for hazardous drinking, and 1.5% experienced the alcohol-specific end-point during the follow-up. Subjective intoxications, hangovers and alcohol-induced pass-outs all predicted future alcohol-specific diagnoses independently of average intake and of several other potential confounders. In identifying baseline hazardous drinking, subjective intoxications had a superior performance in relation to other subjective measures of binge drinking. In identifying future alcohol-specific hospitalizations or death, subjective intoxications had also the best performance, but this was not significantly different from the other binge drinking measures, or average intake.

Conclusions: Subjectively defined intoxications, hangovers and alcohol-induced pass-outs are population-level proxy measures of at-risk drinking patterns.