Gender and Race-Ethnic Differentials in the Criterion Structure of Alcohol Use Disorder Tulshi D. Saha, Sharon M. Smith and Bridget F. Grant

Introduction The Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) assumes that the criteria for alcohol use disorders (AUD) are applicable across a range of populations and can be broadly applied. The goal of this study is to explore the invariance of Alcohol Use Disorder (AUD) criteria across gender and race-ethnicity using IRT based differential criterion functioning (DCF) analysis.

Objective To determine whether abuse, dependence, and proposed consumption criteria displayed DCF, we statistically compared discrimination and severity parameters for each criterion across gender and race/ethnicity using IRT methodology.

Sample National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) –Representative sample of 43,093 adults 18 years and older –Civilian non-institutionalized population –Over-sampled groups African Americans Hispanics Young adults (18-24) Data were analyzed for current regular alcohol drinkers (individuals who drank at least 12 alcoholic drinks in the past year, N = 20,836).

Method A two parameter logistic IRT model was used to define the relationship between the observed responses to the criteria and the underlying unobserved latent trait or construct (Alcohol Use Disorder severity). Using the PARSCALE program, differential criteria functioning (DCF) was examined by comparing a and b parameters for each criterion across sex and race-ethnicity.

Endorsement of AUD Criteria by Race-Ethnicity Proportions endorsing criteria

Endorsement of AUD Criteria by Gender

Differential Criterion Functioning (DCF) of AUD criteria: Gender (Female is reference category)

Bivariate plot of severity parameters of Alcohol Use Disorders- Gender

Gender Differentials of Criterion response curve for Consumption Criterion Exceeded Daily Limits at least Once a Week (Female vs. Male)

Differential Criterion Functioning (DCF) of AUD criteria: Race- Ethnicity (Black is reference category) Alcohol Abuse (A), Dependence (D) and Consumption (C) Criterion Discrimination (a) Severity (b) WhiteBlackHispanicWhiteBlackHispanic ToleranceD1.613* * WithdrawalD Larger/LongerD Quit/ControlD1.389* * Time SpentD Activities given upD Physical/psychological problemsD Neglect rolesA2.585* Hazardous useA * Legal problemA Social/Interpersonal problemsA Exceeded daily limits at least once a weekC1.395* * * * Significant at p <0.05. Blacks are significantly lower Blacks are significantly higher

Bivariate plot of severity parameters of Alcohol Use Disorders- Race/Ethnicity Arrows shows the significant differences

Race-Ethnic Differentials of Criterion response curves for DSM IV Criterion Tolerance (Black vs. White)

Race-Ethnic Differentials of Criterion response curves for DSM IV Criterion Quit /Control (Black vs. White)

Race-Ethnic Differentials of Criterion response curve for Consumption Criterion (Exceeded Daily Limits at least Once a Week)

Test Response Curves For Male and Female on Alcohol Use Disorder

Test Response Curves For Race-Ethnicity on Alcohol Use Disorder

Results  Few AUD criteria exhibited DCF by sex and race-ethnicity.  Impaired control and activities given up had significantly lower discrimination among men than women. The consumption-based criterion had higher discrimination but lower severity among men than women. Other criteria that were significantly higher in terms of severity among men than women were withdrawal, drinking more or for longer than intended and neglect of role responsibilities.  Discrimination associated with tolerance, impaired control and consumption criteria was significantly lower among Whites than Blacks, although severity associated with these criteria were lower for Blacks than Whites. No differences were observed for Hispanics.  DCF in discrimination and severity parameters by gender and race- ethnicity occurred in opposing directions. Consequently, the total response curve (TRC), which is measured at the scale level, was virtually identical for each sex and race-ethnicity group.

Conclusions This study demonstrates that when alcohol use disorder criteria are freely estimated within gender and race-ethnic groups, some of the AUD criteria display statistically significant DCF. When considered at the scale level, however, the measurement displays a very small degree of differential scale function. All groups will have similar expected raw scores on the AUD latent trait.