Is lack of social support associated with a delay in seeking medical care? A cross-sectional study of Minnesota and Tennessee residents using data from the Behavioral Risk Factor Surveillance System.

OBJECTIVE: Previous studies have demonstrated an association between social support and lower morbidity and mortality. Delay in seeking medical care is associated with poor health outcomes. The relationship between social support and delay in seeking medical care has not been established. We sought to determine whether lack of social support is associated with higher rates of delays in seeking needed medical care. METHODS: This is a cross-sectional observational study using data from the 2013 and 2014 Centers for Disease Control Behavioral Risk Factor Surveillance System. Participants who were asked questions about delays in medical care and social support were included. The primary outcome was a self-reported delay in seeking needed medical care. The primary independent variable of interest was a dichotomised measure of social support. Multivariable logistic regression was performed, adjusting for demographics, socioeconomic status, comorbidities and access to care. RESULTS: Participants without social support were more likely to report delaying needed medical care when compared with participants with social support (38%vs19%, p<0.001). The association between lack of social support and delays in care persisted after adjustment for demographics, socioeconomic status, comorbidities and access to care (OR 1.72; 95% CI 1.45 to 2.06; p<0.001). CONCLUSIONS: Lack of perceived social support is associated with patient-reported delay of needed medical care. This association may contribute to the poor health outcomes experienced by those with a lack of social support.

Brief Versus Full Alcohol Use Disorders Identification Test in National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network Clinical Trials.

OBJECTIVES: Alcohol use disorders are common among patients admitted to an ICU, yet systematic screening is rarely performed. We sought to confirm the construct validity of the full Alcohol Use Disorders Identification Test and to evaluate the performance of the brief three-item Alcohol Use Disorders Identification Test-C using the full Alcohol Use Disorders Identification Test as a proxy gold standard in a population of patients with a medical critical illness. DESIGN: Secondary analysis. SETTING: The acute respiratory distress syndrome network, a consortium of 12 university centers (44 hospitals) dedicated to conducting multicenter clinical trials in patients with acute respiratory distress syndrome. SUBJECTS: Patients meeting consensus criteria for acute respiratory distress syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 1,133 patients enrolled in one of three acute respiratory distress syndrome network studies, 1,037 (92%) had full Alcohol Use Disorders Identification Test data available. Of the included patients, 236 (23%) scored above the screening threshold for an alcohol use disorder on the full Alcohol Use Disorders Identification Test. Construct validity analysis of the full Alcohol Use Disorders Identification Test supported a three-factor model. Compared with the full Alcohol Use Disorders Identification Test, the Alcohol Use Disorders Identification Test -C had an area under the receiver operating characteristic curve of 0.99 for men and 0.98 for women. The optimal cutoff was 4 for both genders. At this cutoff, the Alcohol Use Disorders Identification Test -C had a sensitivity of 95% (95% CI, 92-98%) and specificity of 94% (95% CI, 92-96%) for men and sensitivity of 89% (95% CI, 82-96%) and specificity of 99% (95% CI, 98-100%) for women. CONCLUSIONS: Although a three-factor structure for the Alcohol Use Disorders Identification Test was confirmed in ICU patients with acute respiratory distress syndrome, the first three questions focusing on alcohol consumption provide information that is comparable with the full 10-item Alcohol Use Disorders Identification Test screening questionnaire. This study is limited by the lack of a true gold standard, and the performance of the Alcohol Use Disorders Identification Test -C is likely overestimated due to this limitation.