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Despite gout being largely associated with White men, new data suggest gout and hyperuricemia impart a larger burden on other demographic groups, including Black men, Black women, and White women.
A nationally representative race- and sex-specific study of adult patients in the United States reported that gout was more prevalent in those self-reporting Black race when compared with White participants. Investigators believe these differences may be explained by sex-specific differences in diet, as well as social determinants of health and clinical factors, according to results published in JAMA Network.1
“Gout has historically been considered a disease of White men who overindulge in gamey meats and other rich foods,” investigators explained. “However, emerging data suggest gout and hyperuricemia (its causal precursor) impart an even larger burden on other demographic groups, including Black men, Black women, and White women. Indeed, the global frequency and disability burden of gout among women have been rising disproportionately relative to gout among men, with gout among women characterized by a higher frequency of obesity and related cardiometabolic sequalae.”
The cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2016. During in-person interviews, demographics, including race and ethnicity, education level, medical history, income, body mass index, alcohol consumption, and use of diuretics were collected. The main outcome was the prevalence of any race- and sex-specific of gout diagnosis and hyperuricemia and differences before and after adjusting for socioclinical risk factors. Risk factors included lower educational levels, poverty, higher BMI, poor diet, chronic kidney disease (CKD), diuretic use, and a higher number of alcoholic beverages consumed per week.
In total, 18693 participants were included in the analysis, with a total of 3304 Black women (mean age 44.8 years), 6195 White women (mean age 49.8 years), 3085 Black men (mean age 43.6 years), and 6109 White men (mean age 48.2 years). The age-standardized prevalence of gout was 3.5% (95% CI, 2.7%-4.3%) in Black women and 2.0% (95% CI, 1.5%-2.5%) in White women (age-adjusted odds ratio [OR], 1.81 [95% CI, 1.29-2.53]). Prevalence was higher in Black men (7.0% [95% CI, 6.2%-7.9%]) when compared with White men (5.4% [95% CI, 4.7%-6.2%]; age-adjusted OR, 1.26 [95% CI, 1.02-1.55]).
Associations attenuated after adjusting for factors such as diet, body mass index, CKD, and poverty among women and for diet and CKD among men. Hyperuricemia prevalence was consistent among men and women with gout, with the greatest attenuations associated with hyperuricemia among women after adjusting for poverty (OR, 1.71 [95% CI, 1.36-2.15]), BMI (OR, 1.22 [95% CI, 0.96-1.57]), diet (OR, 1.52 [95% CI, 1.19-1.93]), and CKD (OR, 1.01 [95% CI, 0.76-1.35]). In men with gout, the greatest attenuations were reported after adjusting for diuretic use (OR, 1.24 [95% CI, 0.96-1.61]) and CKD (OR, 1.08 [95% CI, 0.81-1.42]).
Results are generalizable to the population of White and Black individuals living in the United States as NHANES data are collected from community-based samples and weighted to the population. The findings for gout were consistent with hyperuricemia. However, the cross-sectional, observational design limited the study and the analyses may have been subject to residual or unmeasured confounding. Lastly, racial differences may be subject to other factors, such as stress, physical activity, and poorer access to health care. Racial differences among men and women are likely associated with these contributors.
“Differences may be explained by racial differences in key socioclinical factors, including excess BMI, poverty, and poor diet as well as CKD in women and by CKD, poor diet, and diuretic use in men,” investigators concluded. “Culturally informed interventions designed to address adiposity and kidney disease and improve diet quality while recognizing the role of poverty in gout among women could help reduce these disparities.”
McCormick N, Lu N, Yokose C. Racial and sex disparities in gout prevalence among us adults. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795143?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=081522. Published August 15, 2022. Accessed August 15, 2022.