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Abstract Number: 1996

Racial/Ethnicity Differences In Health-Related Quality Of Life (HRQOL), Functional Ability and Health Care Utilization In Gout Patients

Aseem Bharat1, Jasvinder A. Singh2,3, Puja Khanna4, Cleopatra Aquino-Beaton5, Jay E. Persselin6, Erin Duffy7, David Elashoff8 and Dinesh Khanna9, 1Medicine/Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 2Rheumatology, Birmingham VA, Birmingham, AL, 3Department of Medicine, University of Alabama, Tuscaloosa, AL, 4Division of Rheumatology, University of Michigan Medical Center, Ann Arbor, MI, 5Rheumatology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, 6Medicine W-111J Div of Rheum, VA Greater Los Angeles Healthcare System, Los Angeles, CA, 7Medicine, University of California Los Angeles, Los Angeles, CA, 8Medicine- Statistic Core, UCLA Department of Medicine Statistics Core, Los Angeles, CA, 9University of Michigan, Ann Arbor, MI

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: functional status, gout, quality of life, race/ethnicity and utilization review

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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.

 

Table 1. SF-36 (Higher score indicates better health) and HAQ scores (Higher score indicates worse health) by Race

 

White

N=107

African American

N=60

 

SF-36 T-Score Values

Mean (SD)

Mean (SD)

T-test

p-value

Physical Functioning (PF)

37.3 (12.1)

34.1 (12.4)

0.12

Role Limitation Physical (RP)

37.5 (12.4)

33.8 (12.1)

0.06

Pain  (BP)

42.6 (12.2)

39.6 (12.6)

0.13

General Health (GH)

43.3 (5.1)

43.5 (4.9)

0.82

Emotional Well-being (MH)

46.3 (12.6)

40.8 (12.9)

0.008

Role Limitation Emotional (RE)

40.6 (16.0)

31.3 (17.0)

0.0005

Social Functioning (SF)

41.5 (12.3)

37.3 (12.8)

0.04

Energy Fatigue (VT)

45.8 (11.3)

45.2 (8.4)

0.71

Physical Health Component (PCS)

38.7 (10.4)

38.1 (10.0)

0.72

Mental Health Component (MCS)

46.2 (14.2)

39.5 (12.9)

0.003

 

 

 

 

 

White

N=105

African American

N=60

 

HAQ

Mean (SD)

[Median (IQR)]

Mean (SD)

[Median (IQR)]

Wilcoxon rank sum p-value

Dressing & Grooming

0.58 (0.74)

[0.00 (1.00)

0.87 (0.70)

[1.00 (1.00)]

0.005

Arising

0.68 (0.69)

[1.00 (1.00)]

0.98 (0.89)

[1.00 (2.00)]

0.04

Eating

0.31 (0.67)

[0.00 (0.00)]

0.52 (0.65)

[1.00 (1.00)]

0.01

Walking

0.73 (0.81)

[1.00 (1.00)]

1.10 (1.02)

[1.00 (2.00)]

0.03

Hygiene

0.70 (0.89)

[0.00 (1.00)]

0.80 (0.92)

[1.00 (1.00)]

0.41

Reach

0.81 (0.82)

[1.00 (1.00)]

0.82 (0.70)

[1.00 (1.00)]

0.70

Grip

0.44 (0.72)

[0.00 (1.00)]

0.95 (0.90)

[1.00 (1.50)]

0.0001

Activities

1.10 (0.99)

[1.00 (2.00)]

1.33 (1.13)

[1.00 (2.00)]

0.23

HAQ Composite Score

0.67 (0.55)

[0.63 (1.00)]

0.93 (0.68)

[0.88 (1.13)]

0.02

 

Table 2. GIS by Race (Higher score indicates worse health)

 

White

N=107

African American

N=60

 

GIS

Mean (SD)

[Median (IQR)]

Mean (SD)

[Median (IQR)]

Wilcoxon rank sum

p-value

Concern Overall

64.3 (27.9)

[75.0 (50.0)]

73.6 (24.6)

[75.0 (37.5)]

0.04

Medication Side Effects

48.8 (27.6)

[50.0 (37.5)]

54.6 (28.9)

[50.0 (50.0)]

0.16

Unmet Treatment Need

33.9 (18.6)

[25.0 (16.7)]

41.4 (20.3)

[33.3 (33.3)]

0.01

Well Being During Attack

51.1 (26.2)

[52.3 (47.7)]

61.5 (25.5)

[64.8 (36.4)]

0.01

Concern During Attack

50.0 (25.2)

[50.0 (50.0)]

60.4 (26.5)

[62.5 (43.8)]

0.01

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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