Session Information
Date: Tuesday, October 23, 2018
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: To determine the latest national prevalence of urate-lowering therapy (ULT) use and achievement of a therapeutic target serum urate level (SUL) in gout patients, and their predictors in the US (National Health and Nutrition Examination Survey [NHANES] 2007-2014).
Methods: Using data from NHANES 2007-2014, we estimated the prevalence of ULT use and achievement of a therapeutic target SUL in patients with gout. During the home interview of NHANES, all participants were asked about a history of health professional- or physician-diagnosed gout and current prescription medications. We defined ULT as taking allopurinol, febuxostat or probenecid, either alone or in combination, and a therapeutic SUL as <6.0 mg/dL. We conducted logistic regression to examine the potential independent associations with purported factors among gout patients.
Results: The prevalence of ULT usage among US gout patients was 32.8% [95% CI 28.3% to 37.6%] in 2007-2014 (39.0% [95% CI 33.6% to 44.7%] among men and 19.4% [95% CI 15.3 to 44.7%] among women). Allopurinol comprised 95.3% [95% CI 92.2% to 98.4%] of ULT usage. Among gout patients, the mean SULs were 5.8 mg/dL [95%CI 5.5 mg/dL to 6.0 mg/dL] among ULT users and 6.9 mg/dL [95% CI 6.7 mg/dL to 7.1 mg/dL] among non-ULT users (mean difference -1.1 mg/dL [95% CI -1.4 mg/dL to -0.8 mg/dL]). Among gout patients, male sex and chronic kidney disease (CKD) were associated with increased fully-adjusted odds of ULT use (Table 1). The prevalence of reaching a therapeutic SUL (<6.0 mg/dL) among gout patients was 38.5% [95% CI 35.3% to 41.7%] in 2007-2014 (32.3% [95% CI 28.3% to 36.5%] among men and 52.0% [95% CI 44.8% to 59.1%] among women). Furthermore, among gout patients, ULT use was associated with a fivefold higher odds for reaching a SUL <6.0 mg/dL. By contrast, male sex, obesity, CKD and thiazide diuretic use were associated with a lower fully-adjusted odds for reaching this target SUL (Table 2).
Conclusion: These findings from a nationally-representative samples of US adults indicate that 32.8% of US gout patients are receiving ULT. Among gout patients, males, and those with either obesity or CKD are more often receiving ULT. The benefit of ULT among gout patients in achieving this target SUL appears apparent. Male sex, obesity, CKD and thiazide diuretic use were inversely associated with reaching a therapeutic SUL, suggesting a potential need for more aggressive therapy among these groups.
Table 1. Predictors of ULT Use Among US Gout Patients, NHANES 2007-2014*
|
|
ULT Use, % (95% CI) |
Unadjusted OR |
Age- and sex-adjusted OR (95% CI) |
Fully-adjusted OR** (95% CI) |
|
Age ≥ 65 |
38.0 (31.4, 45.0) |
1.53 (0.98, 2.39) |
1.71 (1.10, 2.64) |
1.59 (0.97, 2.62) |
|
Male |
38.8 (33.0, 45.0) |
2.66 (1.90, 3.72) |
2.85 (2.08, 3.91) |
3.22 (2.28, 4.54) |
|
African-Americans |
28.3 (22.7, 34.5) |
0.78 (0.50, 1.21) |
0.89 (0.56, 1.41) |
0.85 (0.54, 1.36) |
|
Obesity |
34.5 (28.3, 41.2) |
1.67 (0.92, 3.06) |
1.94 (1.04, 3.60) |
2.06 (1.18, 3.61) |
|
CKD Stage ≥3 |
40.5 (34.2, 47.1) |
1.55 (1.06, 2.26) |
1.54 (1.04, 2.27) |
1.59 (1.04, 2.44) |
|
Hypertension |
33.7 (28.5, 39.3) |
1.15 (0.67, 1.99) |
1.15 (0.67, 1.98) |
1.07 (0.60, 1.89) |
|
Thiazide diuretic |
28.4 (19.8, 38.9) |
0.78 (0.46, 1.31) |
0.80 (0.47, 1.35) |
0.73 (0.42, 1.25) |
|
Alcohol Use |
33.7 (27.7, 40.2) |
1.18 (0.67, 2.08) |
0.81 (0.44, 1.51) |
0.86 (0.45, 1.62) |
|
*Data are presented incorporating sample weights and adjusted for clusters and strata of the complex sample design of NHANES 2007-2014. ** Adjusted for all the other covariates in the table |
||||
Table 2. Predictors of SUL <6.0 mg/dL among US Gout Patients, NHANES 2007-2014*
|
|
SUL <6.0 mg/dL, % (95% CI) |
Unadjusted OR |
Age- and sex-adjusted OR (95% CI) |
Fully-adjusted OR** (95% CI) |
|
ULT Use |
59.0 (50.7, 66.8) |
3.26 (2.25, 4.72) |
4.43 (2.75, 7.14) |
5.53 (3.36, 9.09) |
|
Age ≥ 65 |
41.3 (34.4, 48.6) |
1.11 (0.68, 1.82) |
1.04 (0.63, 1.72) |
0.99 (0.60, 1.64) |
|
Male |
34.5 (29.2, 40.1) |
0.48 (0.30, 0.78) |
0.48 (0.29, 0.79) |
0.26 (0.14, 0.48) |
|
African-Americans |
34.6 (27.9, 42.0) |
0.74 (0.53, 1.04) |
0.67 (0.47, 0.95) |
0.80 (0.55, 1.15) |
|
Obesity |
35.0 (29.7, 40.6) |
0.55 (0.32, 0.97) |
0.53 (0.30, 0.93) |
0.36 (0.19, 0.66) |
|
CKD Stage ≥3 |
33.2 (24.5, 43.3) |
0.69 (0.44, 1.09) |
0.57 (0.35, 0.93) |
0.45 (0.27, 0.75) |
|
Hypertension |
37.6 (32.4, 43.1) |
0.70 (0.46, 1.07) |
0.65 (0.43, 0.99) |
0.81 (0.54, 1.22) |
|
Thiazide diuretic |
27.1 (18.8, 37.5) |
0.50 (0.29, 0.86) |
0.45 (0.26, 0.77) |
0.49 (0.28, 0.86) |
|
Alcohol Use |
38.0 (32.7, 43.5) |
0.70 (0.47, 1.04) |
0.93 (0.60, 1.45) |
0.79 (0.48, 1.31) |
|
* The data were adjusted for clusters and strata of the complex sample design of the National Health and Nutrition Examination Survey (NHANES) 2007–2014, with incorporation of sample weights. 95% CI = 95% confidence interval ** For all the other covariates in the table |
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To cite this abstract in AMA style:
Chen-Xu M, Yokose C, Pillinger M, Choi HK. Prevalence of Urate-Lowering Therapy Use and Target Urate Level Achievement Among Gout Patients in the United States (National Health And Nutrition Examination Survey [NHANES] 2007-2014) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/prevalence-of-urate-lowering-therapy-use-and-target-urate-level-achievement-among-gout-patients-in-the-united-states-national-health-and-nutrition-examination-survey-nhanes-2007-2014/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-urate-lowering-therapy-use-and-target-urate-level-achievement-among-gout-patients-in-the-united-states-national-health-and-nutrition-examination-survey-nhanes-2007-2014/