medwireNews: The higher prevalence of gout among Black men and women than their White counterparts is related to diet, social determinants of health, and chronic kidney disease (CKD), indicates research published in JAMA Network Open.
“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,” Natalie McCormick (Massachusetts General Hospital, Boston, USA) and co-investigators suggest.
National Health and Nutrition Examination Survey (NHANES) responses between 2007 and 2016 showed that the age-adjusted prevalence of gout was 7.0% in Black men, 3.5% in Black women, 5.4% in White men, and 2.0% in White women; Black men and women were a respective 1.81 and 1.26 times more likely to have gout than their White counterparts.
By contrast, there was “no racial difference in the prevalence of gout approximately 2 decades earlier in the 1988-1994 NHANES III” analysis, the investigators observe.
They collated NHANES data for 3085 Black men, 3304 Black women, 6109 White men, and 6195 White women, and on average, Black participants were younger than White participants, had lower education levels, and were more likely to experience poverty.
Black women were also more likely than White women to have key risk factors for gout, namely a higher BMI (mean 32.3 vs 28.7 kg/m2), a higher dietary approaches to stop hypertension score (DASH, mean 28.9 vs 25.3), greater use of diuretics (10.8 vs 8.4%), and a greater likelihood of CKD, defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73m2 (9.6 vs 7.3%).
A similar relationship was found between Black and White men for these risk factors, McCormick et al report.
The exception to this pattern was a lower average weekly intake of alcohol in both Black versus White women (2.0 vs 2.4 drinks) and Black versus White men (5.1 vs 5.7 drinks), they observe.
Among women, the risk for gout was significantly associated with poverty (adjusted odds ratio [OR]=2.36), alcoholic drinks per week (OR=1.11), DASH score (OR=1.20), BMI (OR=1.68), diuretic use (OR=2.17), and CKD (OR=1.71), but not educational attainment.
But stepwise regression analysis found that after accounting for these risk factors, Black women were no longer more likely to have gout than White women.
Similarly, the risk for gout in men was significantly associated with number of alcoholic drinks per week (OR=1.17), DASH score (n=1.14), diuretic use (OR=2.02), BMI (OR=1.15), and CKD diagnosis (OR=2.23), but not poverty. After adjusting for these factors and CKD, Black men were no longer significantly more likely to have gout than White men.
The researchers add that a similar pattern was also found when assessing for hyperuricemia rather than gout.
“[W]e acknowledge that the racial differences reported herein may be influenced by racism and other resultant factors not explicitly included in our models, such as stress, lower levels of physical activity, and poorer access to health care,” the investigators say.
“Importantly, however, the investigated factors, which together nullified the racial differences in gout among men and women, are likely correlated with these and other key contributors,” they write.
“For example, the built environment in some poorer neighborhoods may pose barriers to physical activity, which has implications for BMI, whereas clinician bias and intergenerational mistrust can result in Black individuals receiving lower-quality health care, which has implications for the development of CKD.”
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