Background/Purpose: Gout is a debilitating, chronic disease that requires ongoing treatment and effective self-management. Successful gout treatment depends on multiple factors, including educational attainment. Adequate health literacy enables patients with chronic illnesses, including gout, to better manage their disease and overall health. Evidence suggests that higher health literacy and education may be associated with better self-care and personal health management. Gout is associated with poor health-related quality of life (HRQoL) and greater healthcare utilization (HCU) among US Veterans. However, there is little research on the impact of educational attainment on HRQoL and HCU.

Methods: 186 gout patients with varying levels of educational attainment were recruited in rheumatology and primary care clinics at the West Los Angeles, CA and Birmingham, AL VA facilities. Patients’ clinical status, HRQoL, and HCU were assessed every 3 months for a 12-month period. Educational attainment was self-reported at baseline and patients were categorized into two education levels: 1) No post-high school education and, 2) post-high school (some college, college degree, or graduate school education). HRQoL were measured using the SF-36, HAQ-DI and Gout Impact Scales (GIS) of the Gout Assessment Questionnaire (GAQ). Patients and physicians independently scored the severity of gout on a 0-10 scale. HCU was assessed with the UCSD Health Care Utilization Questionnaire. Demographics, clinical characteristics, HRQoL and HCU of patients with and without post-high school education were compared using Wilcoxon rank sum and Fisher exact tests. P-values less than 0.05 were considered significant.

Results: There were 46 patients with no post-high school education and 138 patients with education beyond high school; 2 patients did not provide their education. Patients with post-high school education were significantly younger than their counterparts, but there was no difference between groups with respect to race, ethnicity or gender (Table). The clinical characteristics, patient severity scores, SF-36, HAQ-DI and GIS scores did not differ between educational attainment groups. However, physician scores for severity of gout were higher for patients with no post-high school education compared to those with higher education. Patients with post-high school education reported a significantly higher frequency of medical office visits (MD, DO, or NP), phone calls to physician or medical staff, and urgent care visits (triage center or emergency department) during the 3-month period prior to baseline. 

Conclusion: VA patients with lower educational attainment had significantly higher physician severity scores, utilized fewer outpatient and urgent care services despite similarities in clinical characteristics and HRQoL as their more educated peers.

*Higher score= worse HRQoL