Once the ‘Disease of Kings,’ Gout Now Reigns Through Poverty, Disparity

Racial and sex-based disparities in prevalence of gout may be explained by differences in diet, kidney health, and other key risk factors, a cross-sectional study found.

After age-standardization, the prevalence of gout among Black women was 3.5% compared with 2.0% among white women (age-adjusted OR 1.81, 95% CI 1.29-2.53), according to findings in JAMA Network Open. Among Black men, the age-standardized prevalence of gout was 7.0%, whereas the prevalence was 5.4% among white men (age-adjusted OR 1.26, 95% CI 1.02-1.55).

However, all risk factors for gout were more common among Black adults than white adults, reported Natalie McCormick, PhD, of Massachusetts General Hospital in Boston, and colleagues.

The associations between race and gout lost statistical significance after adjusting for poverty, diet, BMI, and chronic kidney disease for women and adjusting for diet and chronic kidney disease among men.

“These findings show that gout is no longer exclusive to affluent white men (i.e., the ‘disease of kings’) — if it ever was — while highlighting social determinants of health that could serve as targets for reducing these disparities in the general population,” the authors cautioned.

Recent data have turned the traditional epidemiologic expectations on their head, suggesting a greater burden of gout in Black men, Black women, and white women, the authors explained. Global frequency of gout, and disability caused by it, has also been rising disproportionately in women compared to gout in men, they added.

And the implications aren’t just pain, as a recent study showed an association between gout flares and risk of myocardial infraction and stroke that persisted for 2 months after flareups.

One potential solution is addressing diet quality.

“The serum urate level–lowering effects of [Dietary Approaches to Stop Hypertension] DASH-style diets (vs typical U.S. diets) have been demonstrated in randomized clinical trials, whereas prospective cohort studies have reported inverse associations between DASH adherence (adjusted for total energy intake) and the clinical end point of incident gout,” wrote McCormick and colleagues. “However, greater DASH adherence is also associated with higher food costs; U.S. adults living in poverty have had lower DASH adherence scores than those with higher incomes, as have Black adults compared with white adults, with evidence of higher relative costs to achieve DASH adherence among Black adults than white adults.”

“As such,” the researchers continued, “interventions aimed at promoting healthy eating patterns such as DASH or others described in the Dietary Guidelines for Americans, and reducing barriers to adherence, including for those receiving Supplemental Nutrition Assistance Program benefits (who tend to have poorer-quality diets even compared with eligible individuals not receiving benefits), could reduce racial disparities in the prevalence of gout and hyperuricemia, particularly among women.”

In their study, the age-adjusted prevalence of hyperuricemia (the causal precursor to gout), were similarly higher among Black individuals:

  • Black vs white women: 10.5% vs 5.6% (age-adjusted OR 2.00, 95% CI 1.62-2.47)
  • Black vs white men: 11% vs 7.8% (age-adjusted OR 1.39 95% CI 1.15-1.68)

McCormick and colleagues’ cross-sectional analysis used nationally representative survey data from successive cycles of the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. Data on gout status and serum urate levels were collected and participants self-reported Black or white race. Occurrence of gout was assessed by asking participants if a doctor had ever told them they had gout.

Among the 18,693 participants were 3,304 Black women (mean age 44.8 years), 6,195 white women (mean age 49.8), 3,085 Black men (mean age 43.6), and 6,109 white men (mean age 48.2).

The study was limited by its cross-sectional design that precluded certainty in conclusions on temporal causation and by potential unmeasured confounding factors. Finally, racial differences reported may be influenced by racism or other resultant factors.

The authors concluded by suggesting that culturally informed interventions designed to address adiposity, kidney disease, improve diet quality, and recognizing the role of poverty in gout could help reduce these disparities.

  • author['full_name']

    James Lopilato is a staff writer for Medpage Today. He covers a variety of topics being explored in current medical science research.

Disclosures

The study was funded by the National Institutes of Health, Canadian Institute of Health Research, and the Rheumatology Research Foundation.

McCormick reported receiving grants from the Canadian Institute of Health Research and National Institutes of Health.

Read More

Leave a Reply

Your email address will not be published.