["Addiction, EarlyView. ", "\nAbstract\n\nBackground and aims\nOriginally developed for clinical screening for hazardous alcohol use, the Alcohol Use Disorder Identification Test – Consumption (AUDIT‐C) is also widely used in epidemiological research and monitoring. However, its cutoff values may not suit all purposes, and evidence on its predictive validity is limited. We examined how AUDIT‐C scores relate to subsequent register‐based alcohol‐attributable events across age and sex and identified optimal thresholds for predicting these outcomes.\n\n\nDesign\nFive general population surveys conducted in 2011–2017, linked to nationwide registers with follow‐up until the end of 2023 (total follow‐up 879 964 person‐years).\n\n\nSetting\nNationwide, Finland.\n\n\nParticipants\nAdults aged ≥20 years (n = 103 567).\n\n\nMeasurements\nAUDIT‐C to assess exposure. Outcome: incident alcohol‐attributable events in any of the registers capturing care, deaths and prescription medicines (n = 1444).\n\n\nFindings\nThe hazard of register‐based alcohol‐attributable events increased approximately exponentially with increasing AUDIT‐C score. It rose more strongly among women than men [hazard ratio (HR) = 1.61, 95% confidence interval (CI) = 1.55–1.67 for women; HR = 1.45, 95% CI = 1.40–1.49 for men; P < 0.001 for the sex × AUDIT‐C interaction]. The risk of alcohol‐attributable events was statistically significantly raised at 2 points among women and 3 points among men with 1 point as a reference level. The suggested optimal cutoff values were 2 points for women aged ≥80, 3 points for women aged 65–79 and men aged ≥80, 5 points for women aged 20–64 and men aged 65–79 and 6 points for men aged 20–64.\n\n\nConclusions\nUsing Alcohol Use Disorder Identification Test – Consumption (AUDIT‐C) scores, optimal cutoff values for predicting alcohol‐attributable harm may differ by age and sex, with lower cutoffs for older individuals and women. The ≥65 age group appears to be heterogeneous with regard to vulnerability to alcohol‐attributable harm, which should be considered when establishing cutoffs or guidelines for alcohol use.\n\n"]