Alarming increase in alcohol use during pandemic persists

Embargoed for release until 5:00 p.m. ET on Monday 11 November 2024    

@Annalsofim         
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.         
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1. Alarming increase in alcohol use during pandemic persists

Study highlights urgent public health issue and suggests need for health care interventions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02157

URL goes live when the embargo lifts          

A population-based study of adults aged 18 and older found that alcohol use increased during the COVID-19 pandemic and was sustained post pandemic. These results emphasize an alarming public health issue that remains from the pandemic and suggest the need for policy changes and health care interventions. The findings are published in Annals of Internal Medicine.

Researchers from the University of Southern California and Thomas Jefferson University, Philadelphia studied data from the 2020 and 2022 National Health Interview Survey (NHIS) to determine if increased alcohol use during the pandemic (2020 vs 2018) was sustained post pandemic. The survey collected alcohol use information as well as demographic socioeconomic and health data for more than 24,000 adults aged 18 or older. Adults were categorized by having any alcohol or heavy alcohol use within a year of the survey, and researchers calculated the prevalence rates of both measures of alcohol use. The researchers found that among survey participants, any and heavy alcohol use increased in 2020 and in 2022. The researchers identified stress from the pandemic and disrupted access to medical services as potential causes of the sustained increase in alcohol consumption. Because alcohol is a leading cause of morbidity and mortality in the United States, the researchers assert that this study highlights a serious public health issue stemming from the pandemic that requires clinical, community-based, and policy interventions to mitigate the potential consequences. While the study included only nonmilitary noninstitutionalized adults and excluded certain populations that may be more vulnerable to harmful alcohol use, the results suggest the pertinent need to raise further attention around pandemic-related alcohol use.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Brian P. Lee MD, MAS, please email Laura Nuno at Laura.Nuno@med.usc.edu. To reach Divya Ayyala-Somayajula, MD, please email Angela Showell at Angela.Showell@jefferson.edu.

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2. Study finds evidence gaps among functional capacity assessment tools used before elective surgeries  

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00413   

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02405   

URL goes live when the embargo lifts   

A scoping review of studies evaluating the performance of functional capacity (measure of a patient’s cardiopulmonary fitness) assessment tools administered before elective non-cardiac surgery found that prior research has overwhelmingly focused on predictive validity of functional capacity tests, including cardiopulmonary exercise testing (CPET). The majority of patients in the evaluated studies were involved in studies of CPET (accurate but not accessible) or unstructured assessment (accessible but not accurate). This is important because nearly every preoperative evaluation of a patient scheduled for surgery involves an assessment of functional capacity. The findings are published in Annals of Internal Medicine. 

Researchers from Unity Health Toronto and the University of Toronto conducted a scoping review of 243 original studies to identify which assessment tools have been studied before surgery, what key performance characteristics of these tools have been included in studies, and if clinically relevant subgroups of patients (older adults and patients with obesity, lower limb arthritis or physical disability) have been included in studies. Of the studies reviewed, the researchers identified 26 different tools to assess functional capacity. The researchers found that studies of functional capacity assessment tools focused extensively on their ability to predict future clinical events, and just 4% focused on acceptability to patients, suggesting a mismatch between the research being done and the clinical needs in many health care settings. Most studies included an older patient population, and many studies excluded patients with a physical impairment, with more than a quarter of studies excluding those with a disability. CPET, which is widely considered the gold standard of assessing functional capacity, remains the most extensively researched tool in the surgical setting, however, widespread implementation of CPET is limited because it relies on expensive equipment and skilled personnel and is also time consuming. 

According to the study authors, the review highlights some important areas for research -such as the role of simpler objective exercise tests (e.g., walking tests), the feasibility of different exercise tests, the accuracy of standardized questionnaires, and the performance of tests in vulnerable populations (e.g., individuals with obesity, arthritis, or disability). In addition, research has focused narrowly on whether a tool can predict outcomes, as opposed to some other important characteristics, such as whether patients find it acceptable, whether it is feasible, and whether the results impact on clinical care in a meaningful manner.

An accompanying editorial by Lauren E. Gibson, MD and Jeanine P. Wiener-Kronish, MD of Massachusetts General Hospital highlights the opportunities for the preoperative cardiovascular assessment landscape to evolve in the next 50 years. The authors note that the focus of the preoperative assessment is no longer to avoid complications but to optimize patients for surgery. They suggest a holistic approach that includes assessing a patient’s baseline functional status, enhancing cardiopulmonary endurance and cognition before surgery through prehabilitation and laying out a plan for postoperative rehabilitation. The authors state that by embracing new strategies and tools, including utilization of wearables and adoption of prehabilitation to optimize physical and cognitive health before surgery, we can transform surgery from a hurdle to a launching pad for improved health. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Duminda N. Wijeysundera MD PhD FRCPC, please email communications@unityhealth.to. 

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Also new in this issue:

Misuse of Race in the Interpretation of HbA1c

Elizabeth Selvin, PhD, MPH

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01661

Body Surface Area in Obesity: Clinical Challenges and Call for Improvements

Haoyi Zheng, MD, PhD and Huichun Zhan, MD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0574

Dementia

Esther S. Oh, MD, PhD 

In the Clinic

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02207