‘Gout may not be managed properly’: Premature mortality in gout remains elevated in US, UK
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SAN DIEGO — Premature all-cause mortality in gout remains elevated vs. individuals without gout in the United States and United Kingdom, with worse rates reported among women, according to data presented at ACR Convergence 2023.
The researchers additionally wrote that this “mortality gap” was also present among patients with gout in the United Kingdom.
“Gout is now the most common inflammatory arthritis in the United States,” Natalie McCormick, MD, of Massachusetts General Hospital, told attendees. “Each gout flare may transiently increase the risk of major adverse cardiovascular events.”
To better understand the associations between gout and the risks for cardiovascular and all-cause mortality, adjusting for serum urate and atherosclerotic cardiovascular disease, McCormick and colleagues analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 1988 to 1994, as well as 2007 to 2016. Patients identified from 1988 to 1994 were labeled the “early cohort,” while those from 2007 to 2016 were the “late cohort.”
The researchers additionally conducted subgroup analyses for Black vs. white patients, as well as men vs. women. McCormick and colleagues calculated HRs over 10 years, adjusting for serum urate and atherosclerotic cardiovascular disease risk factors, as well as cardiometabolic comorbidities, kidney function and medications. The findings were then replicated in a U.K. cohort of patients with incident gout from 2006 through 2010.
“This allowed us to assess temporal trends,” McCormick said. “The U.K. cohort enrollment period corresponded to the late cohort in the United States.”
According to the researchers, patients with gout demonstrated higher all-cause mortality rates, compared with those without gout, in both the early (HR = 1.2; 95% CI, 1.03–1.4) and late (HR = 1.19; 95% CI, 1.04–1.37) U.S. cohorts. When adjusting for serum urate level, the trend toward higher all-cause mortality in those with gout persisted in both the early (HR = 1.19; 95% CI, 1.02–1.38) and late (HR = 1.19; 95% CI, 1.03–1.37) cohorts.
“There has not been any change over time,” McCormick said.
Meanwhile, findings from the U.K. cohort demonstrated an increase in all-cause mortality among patients with gout (HR = 1.67; 95% CI, 1.54-1.8). This trend persisted after adjusting for serum urate levels (HR = 1.61; 95% CI, 1.47-1.75), according to the researchers. Mortality risk was higher among women than men across both the U.S. (HR = 1.32; 95% CI, 1.1-1.58) and U.K. (HR = 1.9; 95% CI, 1.55-2.32) cohorts. The researchers additionally reported a non-significant trend toward increased mortality risk among Black patients with gout in both countries.
“We observed this premature mortality gap that persisted in the U.S. population and was replicated in the U.K.,” McCormick said.
McCormick suggested that women and Black patients with gout in the United States and United Kingdom may receive a lower quality of gout care.
“These disparities warrant further investigation,” she said.
McCormick added that the overall trend toward increased all-cause and cardiovascular mortality among all patients with gout may warrant a shift in treatment paradigms.
“Gout may not be managed properly under current care models,” she said.
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McCormick N. Abstract 2428. Presented at: ACR Convergence 2023; Nov. 10-15, 2023; San Diego.
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