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Abstract Number: 2226

Gout and the Risk of Incident Dementia in the Elderly: A Medicare Claims Study

Jasvinder A. Singh1 and John Cleveland2, 1Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 2University of Alabama at Birmingham, Birmingham, AL

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Cerebrovascular disease, Elderly, Epidemiologic methods and gout, Medicare

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Session Information

Date: Tuesday, October 23, 2018

Session Title: Metabolic and Crystal Arthropathies – Basic and Clinical Science Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The pursuit of a link between gout/hyperuricemia and dementia has led to contradictory results.  Most observational studies, including population-based studies, showed that hyperuricemia was associated with a higher risk of dementia and less cognitive dysfunction, while a few studies found hyperuricemia to be associated with a lower risk of dementia.  Recently, a large French population-based study in the elderly (65 years or older) showed that hyperuricemia was associated with a higher risk of dementia and with MRI changes of aging in the brain. Our objective was to assess whether gout in the elderly is associated with a risk of incident dementia.

Methods: We used the 5% Medicare claims data for this observational cohort study.  We used multivariable-adjusted Cox proportional hazard models to assess the association of gout with incident dementia, adjusting for potential confounders/covariates including demographics (age, race, gender), comorbidities (Charlson-Romano comorbidity index), and medications commonly used for cardiac diseases (statins, beta-blockers, diuretics, and angiotensin converting enzyme (ACE)-inhibitors) and gout (allopurinol and febuxostat).  

Results: In our cohort of 1.71 million Medicare beneficiaries, 111,656 had incident dementia.  The crude incidence rates in people without and with gout were 10.9 and 17.9 per 1,000 person-years, respectively.  In multivariable-adjusted analyses, gout was independently associated with a significantly higher hazard ratio of incident dementia, with a hazard ratio [HR] of 1.15 (95% CI, 1.12, 1.18); sensitivity analyses confirmed the main findings. Compared to age 65 to <75 years, older age groups were associated with 3.5 and 7.8-fold higher hazards of dementia; hazards were also higher for females, Black race or people with higher medical comorbidity.

Subgroup analyses indicated that gout was significantly associated with dementia in patients without key comorbidities (CAD, hyperlipidemia, CVD, diabetes, hypertension) with HR ranging 1.19-1.52, but not in patients with each of these comorbidities, except CAD, with HR 0.99-1.04 (Table 1). 

Table 1. Association of gout with incident dementia, in pre-defined subgroups by the presence/absence of CAD, hyperlipidemia, CVD, diabetes or hypertension

Multivariable-adjusted

(Model 1)

Multivariable-adjusted

(Model 1)

HR (95% CI)

P-value

HR (95% CI)

P-value

No CAD

 

CAD

 

Gout

1.19 (1.15, 1.24)

<.0001

1.04 (0.99, 1.09)

0.14

 

 

 

 

No Hyperlipidemia

 

Hyperlipidemia

 

Gout

1.28 (1.23, 1.33)

<.0001

1.02 (0.98, 1.07)

0.26

 

 

 

 

No CVD

 

CVD

 

Gout

1.19 (1.15, 1.22)

<.0001

1.00 (0.94, 1.07)

0.99

 

 

 

 

No Diabetes

 

Diabetes

 

Gout

1.23 (1.19, 1.27)

<.0001

0.99 (0.95, 1.05)

0.81

 

 

No Hypertension

 

Hypertension

Gout

1.52 (1.43, 1.60)

<.0001

1.01 (0.97, 1.04)

0.68

Gout*CAD p-value <0.0001; Gout*hyperlipidemia p-value <0.0001; Gout*CVD p-value <0.0001;

Gout*diabetes p-value <0.0001; Gout*hypertension p-value <0.0001;

Conclusion: Gout was independently associated with 17-20% higher risk of incident dementia in the elderly.  Future studies need to understand the pathogenic pathways involved in this increased risk. 


Disclosure: J. A. Singh, Takeda, Savient, 2,Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon and Allergan pharmaceuticals, WebMD, UBM LLC, Medscape , Fidia pharmaceuticals and the American College of Rheumatology, 5; J. Cleveland, None.

To cite this abstract in AMA style:

Singh JA, Cleveland J. Gout and the Risk of Incident Dementia in the Elderly: A Medicare Claims Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/gout-and-the-risk-of-incident-dementia-in-the-elderly-a-medicare-claims-study/. Accessed January 30, 2023.
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