A majority of individuals who met criteria for severe AUD (77.8%) had a history of mild-to-moderate AUD (9.5% endorsed a single prior criterion, 12.7% endorsed no prior criteria). Consistent with cross-sectional findings, individuals with high-risk mild-to-moderate AUD were more likely (33.4%) to transition to severe AUD than those with low-risk mild-to-moderate AUD (12.9% transitioned to severe AUD) (Table 3 and eResults in Supplement 1). The hazard of transitioning from high-risk mild-to-moderate AUD to severe AUD (adjusted hazard ratio [aHR], 11.62; 95% CI, 7.54-17.92) was more than double that of transitioning to severe AUD from low-risk mild-to moderate AUD after accounting for criterion count (aHR, 5.64; 95% CI, 3.28-9.70; between-group aHR, 2.06; 95% CI, 1.47-2.88) (Figure 2). Earlier ages at first drink, regular drinking, and first intoxication and comorbid ASPD, MDD, and SUDs were significantly associated with progression to severe AUD; however, hazards for these characteristics were considerably lower than hazards for belonging to the high-risk mild-to-moderate AUD group. In multivariate models, high-risk mild-to-moderate was the strongest predictor of progression to severe AUD (aHR, 4.25; 95% CI, 2.57-7.04).
