Session Title: Health Services Research
Session Type: Abstract Submissions (ACR)
Background/Purpose: Gout is caused by chronic high serum uric acid (SUA) levels (i.e., hyperuricemia), which leads to the deposition of monosodium urate crystals in musculoskeletal structures (e.g., joints), kidneys, and other connective tissues and urate crystal deposition disease, which can result in chronic inflammation leading to acute gout flares and tophi. Hyperuricemia is a metabolic disorder caused mainly by inefficient renal excretion of uric acid. Because SUA levels are often not at target, it is important to examine how this may relate to resource use and health utility. Additionally, this study examines other factors such as comorbidities and how they may exacerbate the relationship between high SUA levels, resource use, and health utility.
Methods: The data are from the combined 2012 and 2013 U.S. National Health and Wellness Survey (NHWS), a representative, cross-sectional general health survey (2012 NHWS: N = 71,157; 2013 NHWS: N = 75,000) of which 3,729 self-reported being diagnosed with gout. Those diagnosed were categorized into uncontrolled (N = 2,215) and controlled (N = 344) gout (“controlled gout” defined as: SUA ≤6 mg/dL and no flares in past year), omitting those whose control status was unknown (N = 1,170). Weights were calculated to be representative of the U.S. adult population and analyses were based on the weighted data. Resource use in the past six months, health related quality of life (SF-36v2: mental and physical component summary (MCS, PCS) and SF-6D (health utility), and work productivity loss (WPAI) were assessed across the two groups. Comorbidities (e.g., diabetes, hypertension) and their relationship to resource use and health utility were also examined.
Results: Those with uncontrolled gout reported being hospitalized (13.8% vs. 8.1%) and visiting the ER (22.3% vs. 11.7%) more than those with controlled gout. Additionally, those with uncontrolled gout reported lower MCS (Mean = 47.22 vs. Mean = 51.96), PCS (Mean = 41.95 vs. Mean = 46.32), and health utility (Mean = 0.66 vs. Mean = 0.73) scores than those with controlled gout. Furthermore, those with uncontrolled gout reported higher work productivity loss (24.5% vs 16.2%) and activity impairment (40.2% vs. 28.2%) than those with controlled gout. Having a common comorbidity with uncontrolled gout increased resource usage compared with either 1) those uncontrolled without the comorbidity or 2) with controlled gout, as was shown with diabetes (ER visits: 27.2% vs. 13.7% and 22.6%, respectively).
Conclusion: These findings support that uncontrolled gout results in greater hospitalization and twice as many ER visits than controlled gout. This, combined with lower health utility than controlled gout, suggests a significant humanistic and economic impact. These impacts may be further compounded when comorbidities are present.
Ardea Biosciences, Inc.,
Ardea Biosciences, Inc.,
N. M. Flores,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/resource-use-and-health-related-quality-of-life-burden-of-gout-exacerbated-by-common-comorbidities-results-from-the-2012-2013-national-health-and-wellness-survey/