Background/Purpose: Gout is an inflammatory-metabolic condition that is associated with a heavy burden of cardiovascular-kidney-metabolic (CKM) comorbidities. Accordingly, multimorbidity and polypharmacy are important considerations which could impact gout management yet have been understudied in this population. We sought to determine the prevalence of multimorbidity and polypharmacy among individuals with gout in the United States.

Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2017-18 in which self-reported data on history of gout were ascertained. We examined the national prevalence and population estimates of eight CKM comorbidities, which were defined using a combination of self-reported history, laboratory values, anthropometric measurements, medications, and physical examination data (Table 1). Multimorbidity was defined as having two or more CKM conditions. Polypharmacy was defined as having five or more prescription medications. We conducted logistic regression analyses to quantify the magnitude of association between the presence of gout and the presence of comorbidities, including sub-group analyses based on sex and age ≥65. All statistical analyses were performed using survey commands of SAS to adjust for clusters and strata of the complex sample design and to incorporate sample weights to generate estimates for the total civilian, non-institutionalized US population.

Results: In the NHANES 2017-18, 5.1% (12.1 million) of the US population reported a history of gout. Multimorbidity was present in 76.7% (9.4 million) of individuals with gout compared to 47.1% of individuals without gout, yielding an age- and sex-adjusted odds ratio (OR) of 1.9 (95% CI, 1.1 to 3.2), which was significantly higher among women with gout compared to men with gout (OR 2.7 versus 1.6, p for interaction 0.006) (Table 2). Among those age 65 or greater, individuals with gout were 2.7-fold (1.2 to 6.2) more likely to have multimorbidity compared to those without gout. Individuals with gout were also more likely to experience polypharmacy compared to those without gout, with an age- and sex-adjusted OR of 1.9 (1.1 to 3.4) (Table 2). Examining the different CKM conditions, the most prevalent among individuals with gout were hypertension (64.7%; 7.9 million), dyslipidemia (60.9%; 7.4 million), and obesity (57.3%; 6.8 million) (Table 3). The prevalences were significantly higher among individuals with gout than those without gout for all conditions except dyslipidemia and MASLD, with highest age- and sex-adjusted OR of 2.7 (1.6 to 4.7) for CKD, followed by 2.3 (1.1 to 4.7) for heart failure (Table 3). In our sex-stratified analyses, comorbidities tended to be more frequent among women with gout than men with gout, most notably for hypertension and CHD (Table 3).

Conclusion: A significant proportion of US adults with gout experience multimorbidity and polypharmacy. With the emergence of medications with multiple CKM benefits, such as sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists, additional studies are warranted to determine best practices to streamline gout and CKM comorbidity care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-prevalence-of-multimorbidity-and-polypharmacy-among-us-adults-with-gout-a-general-population-based-study/