Factors Associated With Phosphatidylethanol (PEth) Sensitivity for Detecting Unhealthy Alcohol Use: An Individual Patient Data Meta-Analysis


Judith A. Hahn, University of California, San Francisco
Pamela M. Murnane, University of California, San Francisco
Eric Vittinghoff, University of California, San Francisco
Winnie R. Muyindike, Mbarara University of Science and Technology
Nneka I. Emenyonu, University of California, San Francisco
Robin Fatch, University of California, San Francisco
Gabriel Chamie, University of California, San Francisco
Jessica E. Haberer, Massachusetts General Hospital
Joel M. Francis, National Institute for Medical Research Tanga
Saidi Kapiga, London School of Hygiene & Tropical Medicine
Karen Jacobson, Boston University School of Medicine
Bronwyn Myers, South African Medical Research Council
Marie Claude Couture, University of San Francisco
Ralph J. DiClemente, New York University
Jennifer L. Brown, University of Cincinnati
Kaku So-Armah, Boston University School of Medicine
Mark Sulkowski, Johns Hopkins School of Medicine
Gregory M. Marcus, University of California, San Francisco
Sarah Woolf-King, Syracuse University
Robert L. Cook, University of Florida
Veronica L. Richards, University of Florida
Patricia Molina, LSU Health Sciences Center- New OrleansFollow
Tekeda Ferguson, LSU Health Sciences Center- New OrleansFollow
David Welsh, LSU Health Sciences Center- New OrleansFollow
Mariann R. Piano, Vanderbilt University
Shane A. Phillips, University of Illinois at Chicago
Scott Stewart, University at Buffalo
Majid Afshar, University of Wisconsin
Kimberly Page, University of New Mexico
Kathleen McGinnis

Document Type


Publication Date


Second Department


Publication Title

Alcoholism: Clinical and Experimental Research


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.

First Page


Last Page


PubMed ID