Hmong patients with gout develop earlier, severe disease with worse renal function
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Hmong patients with gout are on average 11 years younger, and demonstrate worse renal function, than non-Hmong patients with similar rates of comorbidities, according to data published in Arthritis Care & Research.
In addition, the data suggested that Hmong patients with gout were more likely to use emergency services and less likely to use preventative medication.
“The Hmong words for gout are ‘mob ko taw vwm,’ which translate to ‘crazy foot pain,’ and Hmong elders state that while gout was a recognized illness in Laos, it is more common now among Hmong living in the U.S.,” Alison Lerman, MD, of the University of Minnesota and HealthPartners Regions Hospital, in Saint Paul, and colleagues wrote. “However, Hmong patients with gout have been shown to be less likely to have comorbidities such as hypertension, diabetes, chronic kidney disease and obesity at initial presentation.”
“They are also less likely to be on diuretics or report heavy alcohol use,” they added. “One prior study showed that Hmong patients are prescribed allopurinol more often than non-Hmong individuals, but they take the medication for a significantly shorter length of time.”
To analyze the differences in demographics, care encounters, comorbidity and clinical characteristics among Hmong and non-Hmong patients with gout, Lerman and colleagues conducted a retrospective chart review at HealthPartners Regions Hospital. The researchers studied all inpatient encounters for adult patients from Jan. 1, 2014, through Dec. 31, 2017, including urgent care, emergency department and hospitalizations in which gout was listed as a primary or secondary diagnosis.
Patients were classified as Hmong if their primary language was Hmong; or if their last
name was one of 18 clans’ names and their country of origin was Laos; or if their last
name was one of 18 clans’ names, their country of origin was the United States and
their self-reported race was Asian. In all, 60 last names associated with clans were included in the criteria. The researchers obtained data on patient demographics, health care encounters, gout-related medication, comorbidities, laboratory clinical values, mortality and length of stay were obtained from electronic enrollment, medical and discharge records.
In all, Lerman and colleagues analyzed data on 2,839 visits from Hmong patients, with 92 encounters being gout-related, and 117,464 visits from non-Hmong patients, with 1,262 of these encounters being gout-related. All gout-related hospital encounters represented 65 Hmong and 976 non-Hmong patients.
According to the researchers, Hmong patients with gout were on average 11 years younger than non‐Hmong patients. However, after adjusting for age, sex and type of visit, Hmong patients demonstrated similar rates of hypertension, diabetes and heart disease despite their younger age. In addition, Hmong patients demonstrated significantly decreased renal function at time of presentation, with an odds ratio for chronic kidney disease among Hmong patients of 2.33, compared with 1.48 for non‐Hmong patients (P < .05).
Hmong patients with gout were more likely to use emergency care rather than elective or urgent care and were less likely to use gout medications prior to admission — 32.3% among Hmong individuals compared with 58.2% in non-Hmong patients. Additionally, the average length of hospital stay was 8.8 days among Hmong patients with gout, compared with 5.2 days for non-Hmong patients (P < .05).
“This study extends previous findings that a diagnosis of gout in the Hmong patient indicates earlier and often more severe disease,” Lerman and colleagues wrote. “While there is not an increase in comorbid conditions, tertiary care system encounters in this population are often longer. Intensive efforts at education, increasing compliance with preventative medications, and identifying the genetic abnormalities responsible for this increased burden of gout are currently underway.”
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