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“Understanding the drivers of this increased risk in women with gout warrants further investigation in larger datasets," investigators stated.
Data from a UK Biobank cohort suggest that gout is not only a risk factor for COVID-19-related death, but that risk increases in women with gout, independent of metabolic comorbidities, according to a study published in The Lancet.1
The UK Biobank, which contains 500,000 volunteers aged 49-86 years of age, included data from 15,871 patients with gout. COVID-19 diagnosis was defined as those with a positive SARS-CoV-2 test or ICD-10 code for confirmed or probable COVID-19. Gout was determined by self-reported gout, hospital-diagnosed gout, and those receiving allopurinol or sulfinpyrazone.
Multivariable-adjusted logistic regression was used to assess the association in 4 case-controlled datasets. Analysis A determined any association between gout and COVID-19 diagnosis in a population-based cohort (16,898 patients and 442,939 controls); analysis B determined any association between gout and COVID-19-related deaths in participants diagnosed with COVID-19; analysis C focused on associations between gout and COVID-19-related deaths in a population-based group; and analysis D tested for any association within the subset of the UK Biobank with data relating to colchicine and urate-lowering therapy prescriptions and the risk of COVID-19-related death for patients with gout.
Models 1 and 2 adjusted for age, ethnicity, BMI, sex, smoking status, and Townsend deprivation index, with Model 2 also adjusting for 16 additional comorbidities of gout and risk factors for COVID-19 death.
Of the 459,837 participants included in the population-based cohort, 15,871 were diagnosed with gout. Between March 2020 and March 2021, 0.9% of patients with gout died due to COVID-19 compared with only 0.2% of controls. Additionally, patients who died had a higher percentage of metabolic-based diseases, such as chronic kidney disease (19.1%) and diabetes (30.7%) when compared with controls (3.2% and 7.3%, respectively).
Gout was associated with COVID-19-related death in the entire cohort (1.29, 1.06–1.56), with women experiencing an increased risk (1.98, 1.34–2.94) when compared with men (1.16, 0.93–1.45) (1.3% vs 0.8%, respectively). Additionally, women with gout had a higher number of comorbidities than men, while men had a higher number in the entire cohort.
No significant differences were seen in the risk of COVID-19-related death regarding urate-lowering therapy or colchicine treatment.
COVID-19 diagnosis was significantly higher in patients who were not vaccinated (1.21, 1.11–1.30) when compared with the vaccinated cohort (1.09, 0.65–1.85).
Data may not be generalizable as most patients were middle-aged White British patients from the UK. There is also a possibility of unidentified COVID-19-related deaths. Another limitation is that before August 2020, Public Health England had listed cause of death as COVID-19 if patients had ever received a positive test result, thus some of these deaths are inevitably not related to COVID-19. However, the organization estimates 96% accuracy. Additionally, disease activity, individual behavior modification, and medication adherence were not assessed.
“We found an increased risk of COVID-19-related death in people with gout, with a greater burden in women than men,” investigators concluded. “Understanding the drivers of this increased risk in women with gout warrants further investigation in larger datasets.”
Topless RK, Gaffo A, Stamp LK, Robinson PC, Dalbeth N, Merriman TR. Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study. Lancet Rheumatol. 2022;4(4):e274-e281. doi:10.1016/S2665-9913(21)00401-X