Diet, social determinants of health, CKD could explain racial disparities in gout
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Black adults showed a higher prevalence for gout than white adults during a 10-year period, even after adjusting for diet, social determinants of health and chronic kidney disease, according to data published in JAMA Network.
“Our objective was to investigate current racial differences in gout prevalence among women and men in the U.S. general population and identify sex-specific factors that may explain these differences,” Natalie McCormick, PhD, from the clinical epidemiology program in the division of rheumatology, allergy and immunology at Massachusetts General Hospital, and colleagues wrote. “We hypothesized these differences would be present at the national level and would be associated, in a sex-specific manner, with racial differences in social and lifestyle factors, diuretic use and CKD.”
In a cross-sectional study, researchers evaluated 18,693 adults with data on gout status and serum urate levels. Data were derived from the National Health and Nutrition Examination Survey (NHNES) from 2007 to 2016.
Participants self-reported race, excess BMI, CKD, poverty, poor-quality diet, low educational level, alcohol consumption and diuretic use in interviews. Additionally, investigators of the NHNES asked participants, “Has a doctor or other health professional ever told you that you had gout?”
Researchers considered the primary outcome as the race- and sex-specific prevalence of diagnosed gout and hyperuricemia and participants’ differences before and after adjusting for potential social and clinical risk factors.
Researchers calculated the prevalence of gout and hyperuricemia within U.S. adult Black and white populations according to sex, then measured the relationship between each risk factor and the odds of gout among men and women, adjusting for age and race. Using stepwise logistic regression, researchers added potential risk factors one by one to display how the correlation between self-reported Black race and gout changed with each factor.
Final analysis included 3,304 Black women (mean age was 44.8 years), 6,195 white women (mean age was 49.8 years), 3,085 Black men (mean age was 43.6 years) and 6,109 white men (mean age was 48.2 years). Researchers identified the age-standardized prevalence of gout was 3.5% in Black women and 2% in white women, whereas it was 7% in Black men and 5.4% in white men. The correlations remained after adjusting for poverty, diet, BMI and CKD, but then nullified after adjusting for all risk factors.
Overall, gout was 1.8 times more prevalent among Black women than white women, and 1.3 times more prevalent among Black men than white men.
“Although gout has historically been viewed as a disease of wealthy white men who could afford to overindulge in alcohol and purine-rich foods, the association between socioeconomic status and gout and hyperuricemia has garnered little empirical study and remains unclear. Our contemporary findings show that poverty (ie, low household income level) is associated with more than two times greater odds of gout among women and may explain a portion of the racial differences among women with gout, whereas there was no association between poverty and gout among men,” McCormick and colleagues wrote. They added, “Culturally informed interventions designed to address adiposity and kidney disease and improve diet quality while recognizing the role of poverty in gout among women could help reduce these disparities.”
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