Mortality Risk in Gout Has Persisted for Decades Despite Advances in Care

Article

NHANES data presented at EULAR 2023 offer insight into trends in the risk of mortality over a time period beginning in 1988 and lasting through 2016.

Natalie McCormick, PhD | Credit: American College of Rheumatology

Natalie McCormick, PhD
Credit: American College of Rheumatology

An analysis of data from the National Health and Nutrition Examination Survey (NHANES) suggests the risk of mortality associated with gout has persisted across the last 3 decades in the US.

Presented at the European Congress of Rheumatology (EULAR) 2023 annual meeting, results of the study indicate the adjusted risk of all-cause mortality among people with gout in the US has remained consistent dating back to the 1980s despite advances in technology and pharmacological treatment options.1

“We looked at risk of mortality among people with and without gout in a representative sample of the US population, and found that there was an increased mortality risk, and it has not improved over time,” said lead investigator Natalie McCormick, PhD, an epidemiologist at Harvard Medical School, in an interview with HCPLive.

According to an analysis of NHANES data presented at EULAR 2023, the overall prevalence of gout among US adults had increased from 3.6% in 2011-2012 to 5.1% in 2017-2018.2 In the current study, McCormick and fellow investigators leveraged data from NHANES with the intent of comparing the risk of all-cause and cardiovascular mortality among patients with gout using historic and contemporary data.1

For the purpose of analysis, the early cohort included data recorded within NHANES survey cycles occurring from 1988-1994 and the late cohort included data from NAHNES survey cycles occurring from 2007-2016. The primary outcome of interest for the study was the 10-year risk of all-cause mortality relative to their counterparts without gout. Investigators pointed out models used to estimate hazard ratios for mortality were adjusted for atherosclerotic cardiovascular disease risk factors, cardiometabolic comorbidities, kidney function, and relevant medication use.1

Upon analysis, results suggested the risk of all-cause mortality was 19% greater for those with gout relative to their counterparts without gout among the entire study cohort (aHR, 1.19 [95% Confidence interval [CI], 1.08-1.32]). Further analysis revealed there was little difference in risk observed for those in the early (aHR, 1.19 [95% CI, 1.02-1.38]) and late (aHR, 1.19 [95% CI, 1.03-1.37]) cohorts.1

Results of subgroup analysis suggested the risk of all-cause mortality was greater among women (aHR, 1.33 [95% CI, 1.11-1.60]; P = .03), Black individuals (aHR, 1.40 [95% CI, 1.12-1.74]), and older individuals, with those aged greater than 60 years of age having a 62% greater relative risk of mortality compared to those aged 60 years or less ( aHR, 1.62 [95% CI, 1.19-2.19]; P < .001). Investigators noted the risk of cardiovascular mortality was 39% greater among those with gout relative to their counterparts among those in the late cohort.1

During her interview with HCPLive Rheumatology, McCormick underlined the importance of precision medicine and taking an individualized approach to patient care.

“What potentially could help is maybe more supplementary medications,” McCormick explained. “There has been evidence of daily low dose colchicine use helping with cardiovascular risk in gout populations and others. This might be a call for that because urate-lowering therapy can be great at reducing flare risk, but evidence does not suggest that it has much of an impact on the cardiovascular risk that people with gout face.”

References:

  1. McCormick N, Yokose C, Lin K, Lu L, Joshi A, Choi H. Persistent Premature Mortality in Gout: Nationwide Prospective Cohort Study. Paper presented at: European Congress of Rheumatology (EULAR) 2023. Milan, Italy. May 31 – June 3, 2023.
  2. Campbell P. Report: For US patients, gout burden greatest among Asian Americans. HCP Live. May 31, 2023. Accessed June 8, 2023. https://www.hcplive.com/view/report-for-us-patients-gout-burden-greatest-among-asian-americans.
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