Session Information
Session Title: Metabolic and Crystal Arthropathies II
Session Type: Abstract Submissions (ACR)
Background/Purpose: Due to limited/no data for race/ethnicity, our objective was to assess whether HRQOL functional ability and health care utilization in gout patients differs by race/ethnicity.
Methods: This prospective cohort study included 186 veterans with gout (predominantly male) recruited at Veterans Affairs (VA) rheumatology and primary care clinics at the West Los Angeles, CA and Birmingham, AL facilities. We assessed HRQOL (with short-form 36 and the Gout Impact Scales (GIS) of the Gout Assessment Questionnaire (GAQ)); functional ability with Health assessment questionnaire-disability index (HAQ-DI); and health care utilization (patient self-reported University of California at San Diego (UCSD) Health Care Utilization Questionnaire) every 3 months for a 9-month period. Comparisons were made using the student’s t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate.
Results: Race/ethnicity data were available for 167 patients, 107 Caucasian and 60 African-American. The cohort mean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 6% did not graduate high school, 21% had gouty tophi, the mean serum urate was 8.3.
Compared to Caucasians, African-American gout patients were younger (61.1 vs. 67.3 years, p=0.0003), had higher serum urate (9.6 vs. 7.9 mg/dl, p=0.005), but similar patient (6.0 vs. 5.4, p=0.27) and physician assessment (3.3 vs. 2.9, p=0.53) of gout severity.
HRQOL Differences: African American patients with gout had lower scores on SF-36 mental health, role emotional, social functioning domains and MCS (but not PCS) relative to White patients (P≤0.04 for all; table 1).
On the GIS, African American scored higher in the areas of gout concern overall, unmet treatment need, well-being during attacks, concern during attacks, and overall average GIS (Table 2), but not medication side effects.
Functional limitation: Compared to Caucasians, African American had higher/worse HAQ scores overall and lower scores in 5 of the 8 activity domains of Dressing & Grooming, Arising, Eating, Walking, and Grip, indicating more difficulty with these tasks (Table 1).
Conclusion: This is the first prospective cohort study to show that African-American patients with gout have significantly worse emotional, social, and mental wellbeing/HRQOL and functional ability than Caucasians. Further research is needed into the determinants of this poorer HRQOL and function to target interventions to modifiable mediators of this relationship.
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Table 1. SF-36 (Higher score indicates better health) and HAQ scores (Higher score indicates worse health) by Race |
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White N=107 |
African American N=60 |
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SF-36 T-Score Values |
Mean (SD) |
Mean (SD) |
T-test p-value |
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Physical Functioning (PF) |
37.3 (12.1) |
34.1 (12.4) |
0.12 |
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Role Limitation Physical (RP) |
37.5 (12.4) |
33.8 (12.1) |
0.06 |
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Pain (BP) |
42.6 (12.2) |
39.6 (12.6) |
0.13 |
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General Health (GH) |
43.3 (5.1) |
43.5 (4.9) |
0.82 |
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Emotional Well-being (MH) |
46.3 (12.6) |
40.8 (12.9) |
0.008 |
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Role Limitation Emotional (RE) |
40.6 (16.0) |
31.3 (17.0) |
0.0005 |
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Social Functioning (SF) |
41.5 (12.3) |
37.3 (12.8) |
0.04 |
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Energy Fatigue (VT) |
45.8 (11.3) |
45.2 (8.4) |
0.71 |
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Physical Health Component (PCS) |
38.7 (10.4) |
38.1 (10.0) |
0.72 |
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Mental Health Component (MCS) |
46.2 (14.2) |
39.5 (12.9) |
0.003 |
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White N=105 |
African American N=60 |
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HAQ |
Mean (SD) [Median (IQR)] |
Mean (SD) [Median (IQR)] |
Wilcoxon rank sum p-value |
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Dressing & Grooming |
0.58 (0.74) [0.00 (1.00) |
0.87 (0.70) [1.00 (1.00)] |
0.005 |
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Arising |
0.68 (0.69) [1.00 (1.00)] |
0.98 (0.89) [1.00 (2.00)] |
0.04 |
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Eating |
0.31 (0.67) [0.00 (0.00)] |
0.52 (0.65) [1.00 (1.00)] |
0.01 |
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Walking |
0.73 (0.81) [1.00 (1.00)] |
1.10 (1.02) [1.00 (2.00)] |
0.03 |
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Hygiene |
0.70 (0.89) [0.00 (1.00)] |
0.80 (0.92) [1.00 (1.00)] |
0.41 |
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Reach |
0.81 (0.82) [1.00 (1.00)] |
0.82 (0.70) [1.00 (1.00)] |
0.70 |
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Grip |
0.44 (0.72) [0.00 (1.00)] |
0.95 (0.90) [1.00 (1.50)] |
0.0001 |
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Activities |
1.10 (0.99) [1.00 (2.00)] |
1.33 (1.13) [1.00 (2.00)] |
0.23 |
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HAQ Composite Score |
0.67 (0.55) [0.63 (1.00)] |
0.93 (0.68) [0.88 (1.13)] |
0.02 |
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Table 2. GIS by Race (Higher score indicates worse health) |
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White N=107 |
African American N=60 |
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GIS |
Mean (SD) [Median (IQR)] |
Mean (SD) [Median (IQR)] |
Wilcoxon rank sum p-value |
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Concern Overall |
64.3 (27.9) [75.0 (50.0)] |
73.6 (24.6) [75.0 (37.5)] |
0.04 |
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Medication Side Effects |
48.8 (27.6) [50.0 (37.5)] |
54.6 (28.9) [50.0 (50.0)] |
0.16 |
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Unmet Treatment Need |
33.9 (18.6) [25.0 (16.7)] |
41.4 (20.3) [33.3 (33.3)] |
0.01 |
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Well Being During Attack |
51.1 (26.2) [52.3 (47.7)] |
61.5 (25.5) [64.8 (36.4)] |
0.01 |
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Concern During Attack |
50.0 (25.2) [50.0 (50.0)] |
60.4 (26.5) [62.5 (43.8)] |
0.01 |
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Average GIS Score |
50.8 (18.9) [51.6 (28.1)] |
60.3 (19.6) [62.5 (32.3)] |
0.004 |
Disclosure:
A. Bharat,
None;
J. A. Singh,
Takeda, Savient,
2,
Savient, Takeda, Ardea, Regeneron, Allergan,
5,
URL pharmaceuicals Novartis,
5;
P. Khanna,
None;
C. Aquino-Beaton,
None;
J. E. Persselin,
None;
E. Duffy,
None;
D. Elashoff,
None;
D. Khanna,
savient,
2,
Savient, Takeda, and AZ,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racialethnicity-differences-in-health-related-quality-of-life-hrqol-functional-ability-and-health-care-utilization-in-gout-patients/