Background/Purpose: Venous thromboembolism (VTE), manifested by deep venous thrombosis (DVT) and pulmonary embolism (PE), is a common medical problem with an estimated incidence of 1–2 per 1000 person-years¹. Patients who develop VTE have high mortality rates of 11–30% per annum^2,3. While VTE is known to be associated with surgery, immobilization, and cancer (2), some studies have also reported an increased risk of VTE in patients with gout ^4-6. However, there is little nationwide data in the United States (US) on the clinical and economic consequences of VTE in persons with gout. This study examined VTE hospitalizations in patients with gout in the US and estimated their clinical and economic impact.

Methods: The National Inpatient Sample (NIS) is a stratified random sample of all US community hospitals designed to produce national estimates of inpatient utilization, cost, and outcomes. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. Unweighted it contains data from around 7 million hospitalizations a year, weighted it estimates around 35 million hospitalizations nationally. We examined all inpatient hospitalizations in the NIS in 2020, the most recent year of available data, with a primary or secondary diagnosis of gout and VTE.

Results: In 2020, there were 32.4 million all-cause hospitalizations in the US, with 19.7 million occurring in persons 45 years or older. Of these, 785,905 hospitalizations occurred in people aged 45 years and over with a diagnosis of gout. This population had a mean age of 71.8 years (95% confidence limits: 71.7–71.9 years) and were more likely to be men (68.8%). Of these hospitalizations, 79,260 (10.1%) also had a concomitant diagnosis of VTE (Table 1). As a comparison, only 8.2% of hospitalizations in the general population 45 years or older had a concomitant diagnosis of VTE (p < 0.001 compared to persons with gout). Persons with gout and VTE had a mean age of 71.6 years (95% confidence: limit 71.4–71.8 years) and were mostly men (66%, Table 2). The average cost of each hospitalization was $76,373 (95% confidence limit $73,343–$79,403), with a total annual national cost of over $6.1 billion.

Conclusion: One out of 10 hospitalizations in persons with gout have a concomitant diagnosis of VTE, with considerable clinical and economic consequences. VTE occurred more frequently in the presence of gout in hospitalized patients over the age of 45 years (1/10 vs. 1/12 patients) and resulted in considerable economic burden. These findings suggest that VTE prevention measures and patient education on VTE signs/symptoms may be of particular importance in patients with gout.

References
1. Cushman M, et al. Am J Med 2004;117:19-25.
2. Naess IA, et al. J Thromb Haem 2007;5:692-9.
3. Heit JA, et al. Arch Intern Med 1999;159:445-53.
4. Sultan AA, et al. CMAJ 2019;191:E597-603.
5. Kubota Y, et al. Thromb Res 2016;144:144-8.
6. Li L, et al. Rheumatology (Oxford) 2020;59:1099-107.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/venous-thromboembolism-in-patients-with-gout-in-the-us/