Diet, social determinants of health, CKD could explain racial disparities in gout

August 24, 2022

2 minute read


Disclosures: McCormick reports receiving grants from the Canadian Institutes of Health Research and the NIH while conducting the study.

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According to data published in JAMA Network.

“Our goal was to investigate current racial differences in the prevalence of gout among women and men in the general US population and to identify gender-specific factors that may account for these differences,” Natalie McCormick, PhD, of the Clinical Epidemiology Program in the Division of Rheumatology, Allergy, and Immunology at Massachusetts General Hospital, and colleagues wrote. “We hypothesized that these differences would be present at the national level and would be associated, in a sex-specific way, with racial differences in social and lifestyle factors, diuretic use, and CRF. .”

Infographic showing prevalence of gout in National Health and Nutrition Survey patients.

The researchers identified that the age-standardized prevalence of gout was 3.5% in black women and 2% in white women, while it was 7% in black men and 5. 4% among white men. Data are from McCormick N, et al. JAMA. 2022;doi:10.1001/jamanetworkopen.2022.26804.

In a cross-sectional study, researchers assessed 18,693 adults with data on gout status and serum urate levels. The data comes from the National Health and Nutrition Survey (NHNES) from 2007 to 2016.

Participants reported their race, excessive BMI, chronic kidney disease, poverty, poor quality diet, low level of education, alcohol consumption and use of diuretics during the interviews. Additionally, NHNES investigators asked participants, “Has a doctor or other healthcare professional ever told you that you have gout?”

Researchers considered the primary outcome to be the race- and gender-specific prevalence of diagnosed gout and hyperuricemia and differences between participants before and after adjusting for potential social and clinical risk factors.

The researchers calculated the prevalence of gout and hyperuricemia in black and white American adult populations by sex, then measured the relationship between each risk factor and the risks of gout in men and women, adjusting for age and race. Using stepwise logistic regression, the researchers added potential risk factors one at a time to show how the correlation between self-reported blackness and gout changed with each factor.

The final analysis included 3,304 black women (mean age 44.8), 6,195 white women (mean age 49.8), 3,085 black men (mean age 43.6), and 6,109 white males (mean age 48.2). The researchers identified that the age-standardized prevalence of gout was 3.5% in black women and 2% in white women, while it was 7% in black men and 5. 4% among white men. The correlations remained after adjusting for poverty, diet, BMI, and CRI, but then canceled out after adjusting for all risk factors.

Overall, gout was 1.8 times more common in black women than white women and 1.3 times more common in black men than white men.

“Although gout has always been considered a disease of wealthy white men who could afford to consume too much alcohol and purine-rich foods, the association between socioeconomic status and gout and the hyperuricemia has been the subject of few empirical studies and remains uncertain.Our contemporary results show that poverty (i.e. a low level of household income) is associated with a risk of gout more than twice higher in women and may explain some of the racial differences in women with gout, whereas there was no association between poverty and gout among men,” McCormick and colleagues wrote. added: “Culturally informed interventions designed to address adiposity and kidney disease and improve diet quality while recognizing the role of poverty in gout in women could help reduce these di separates.

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