Background/Purpose: Gout is a chronic inflammatory disease caused by the deposition of monosodium urate crystals in joints and soft tissues. The overall prevalence is increasing worldwide, with African-Americans (AA) being affected more than Caucasians.  We evaluated the association between race, uric acid levels, urate-lowering therapy (ULT) and resource utilization in patients with gout in a large health system.

Methods: The study population was a cohort of African-American and Caucasian men and women with gout who had an inpatient or emergency department encounter at a large health system in Southwestern Pennsylvania between 10/1/2008 and 9/30/2011.  To be included, subjects had to have an ICD-9-CM code for gout (274.xx) as a either primary or secondary diagnosis during the study timeframe. A mean uric acid (UA) level was calculated for each patient across the study period and categorized as either <6 or ≥ 6 mg/dL.  ULT was identified during the hospitalization. All patient encounters where gout was listed as the primary diagnosis were collected to assess gout resource use. Chi-square and T-tests were used to compare categorical and continuous data, respectively.  Logistic regression was conducted to determine the relationship between race, UA levels, and resource utilization.

Results: There were 8,483 patients who met study criteria: 5,998 (71%) were male and 7,073 (83%) were Caucasian. UA levels were available in 43% of patients; a higher percentage of AA had UA levels assessed compared to Caucasians (53% vs. 41%, p<0.001). After stratifying by sex, mean UA levels were similar for females, however AA men had higher mean UA levels than Caucasian men (7.9 vs. 7.1, p<0.001).  Despite having higher UA levels, only 27% of AA received ULT compared to 39% of Caucasians (p<0.001). There were no differences between the sexes with respect to the use of ULT. Multivariate regression analysis revealed that patients with a UA level ≥ 6 mg/dL were more likely to be AA race (OR=1.5), male (OR=1.2), and have chronic kidney disease (OR=1.4) and less likely to be on ULT (OR=0.7). Additionally, after controlling for other variables, AA patients (OR=2.6) and those with high UA levels (OR=2.5) were more likely to have inpatient and emergency department visits for gout (p<0.001).

Conclusion: AA race is associated with higher UA levels and lower use of ULT.  AA patients and those with high UA levels were more likely to have emergency department visits or be hospitalized for gout. Improving access to ULT may reduce the burden of gout in African-Americans and reduce overall healthcare costs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/relationship-between-race-uric-acid-levels-urate-lowering-therapy-and-resource-use-in-patients-with-gout/