Background/Purpose: Gout is the most common form of inflammatory arthropathy, with a prevalence ranging from 0.1% to approximately 10% worldwide. Despite a well-established association between gout and renal disease, the real-world data on the mortality rate due to renal disease or failure in patients with gout is not well established. Hence, we aim to assess the longitudinal trends in mortality rates attributed to renal disease in patients with gout. In addition, we aim to analyse for disparities in regard to race, sex, and geographical location in the United States.

Methods: Age-adjusted mortality rates (AAMR) per 100,000 individuals were obtained from the Centers of Disease Control and Prevention WONDER database from the years of 1999-2020. Joinpoint regression was applied to calculate the annual percentage change (APC) to evaluate significant differences in the change of AAMR over time.

Results: A total of 9263 deaths due to renal failure occurred in patients with Gout from 1999 to 2020. The AAMR from 1999 to 2012 insignificantly increased (APC 1.31) and sharply declined from 2012 to 2020 (APC -34.96). The same trend was reflected when stratified for females and males. The AAMR in urban areas had a trivial decline from 1999 to 2012 (APC 0.86) whereas significantly declined from 2012 to 2015 (APC -34.48). In rural areas, the AAMR initially significantly increased from 1999 to 2005 (APC 10.13), then decreased from 2005 to 2012 (APC -0.66) and subsequently significantly reduced from 2012 to 2015 (APC -32.79). The absolute AAMR for African Americans as compared to Whites were significantly different from 1999 to 2012. From 2012 to 2015, both subgroups had a statistically significant decline in AAMR, African Americans (APC -43.38 [-54.92, -21.89]) and Whites (APC -30.62 [-38.73, -3.42]). From 2015-2020, the AAMR remained fairly stable and similar in absolute numbers for both subgroups.

Conclusion: From 1999 to 2012, renal failure-related mortality in gout patients initially increased but had a significant drop from 2012 to 2015. Mortality rates reflected similarly in both sexes, females and males. Rural areas had an initial increase in mortality as compared to urban areas from 1999 to 2005. Blacks had a higher absolute mortality as compared to Whites until 2012 after which there was a sharp decline to similar rates from 2012 to 2015. These potential disparities warrant further research into quality of care delivered and phenotype of disease based on race and rural status. In addition, these findings may point towards improvement and standardization of care amongst different races and geographical areas after the introduction of the American College of Rheumatology (ACR) 2012 Gout guidelines.

Annual Percentage Change in Gout and Renal Failure-Related Mortality by Year and Gender

Annual Percentage Change in Gout and Renal Failure-Related Mortality by Year and Race

Annual Percentage Change in Gout and Renal Failure-Related Mortality by Year and Urban-Rural

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gout-and-renal-failure-related-mortality-trends-in-usa-from-1999-2020-analysis-of-cdc-wonder-database/