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11-07-2018 | Gout | Article

Gout prevalence and predictors of urate-lowering therapy use: results from a population-based study

Journal: Arthritis Research & Therapy

Authors: Huai Leng Pisaniello, Susan Lester, David Gonzalez-Chica, Nigel Stocks, Marie Longo, Greg R. Sharplin, Eleonora Dal Grande, Tiffany K. Gill, Samuel L. Whittle, Catherine L. Hill

Publisher: BioMed Central

Abstract

Background

Gout has an increasing global prevalence. Underutilization of urate-lowering therapy (ULT) is thought to be common, via both suboptimal dosing and poor medication adherence. The aims of this study were to determine the prevalence of self-reported gout and the key predictors of ULT use in those with gout in a representative population survey in South Australia.

Methods

Data were obtained from the Spring 2015 South Australian Health Omnibus Survey, a multilevel, systematic, survey in a representative population sample involving face-to-face interviews (n = 3005). This study analyzed responses from respondents aged ≥ 25 years (n = 2531) about self-reported gout, ULT use, sociodemographic factors, lifestyle factors, and comorbidities, using survey weighting. Univariate and subsequent adjusted logistic regression analyses on self-reported gout were performed. ULT use was divided into three categories (never use, prior use, and current use) and these data were analyzed using a multinomial logistic regression model.

Results

Self-reported gout prevalence was 6.8% (95% CI 5.8, 7.9). The mean age of respondents with gout was 64 years (standard deviation 16) and 82% were male. As expected, older age, male gender, lower socioeconomic status (SES), and higher body mass index (BMI) were associated with gout, as were high alcohol consumption, current smoking, other forms of arthritis, and hypertension or hypercholesterolemia medication, after adjustment for sociodemographic variables. Two thirds of respondents with gout reported ULT use (36% current; 29% previous) with only 55% continuing treatment. Predictors of ULT use included male gender, low SES, and concomitant cholesterol-lowering therapy. Respondents with gout with a higher BMI were more likely to remain on ULT.

Conclusions

Despite gout being a common, potentially disabling joint disease, only 55% of respondents with gout in this study adhered to ULT. Identification of key predictors of ULT use will provide guidance on prescribing strategy in clinical practice and on the quality of gout care in the community.

Smith EU, Diaz-Torne C, Perez-Ruiz F, March LM. Epidemiology of gout: an update. Best Pract Res Clin Rheumatol. 2010;24(6):811–27.CrossRefPubMed

Hak AE, Curhan GC, Grodstein F, Choi HK. Menopause, postmenopausal hormone use and risk of incident gout. Ann Rheum Dis. 2010;69(7):1305–9.CrossRefPubMed

Kramer HM, Curhan G. The association between gout and nephrolithiasis: the National Health and nutrition examination survey III, 1988-1994. Am J Kidney Dis. 2002;40(1):37–42.CrossRefPubMed

Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study. Ann Rheum Dis. 2015;74(4):661–7.CrossRefPubMed

Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, Nuki G. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis. 2008;67(7):960–6.CrossRefPubMed

Rai SK, Avina-Zubieta JA, McCormick N, De Vera MA, Shojania K, Sayre EC, Choi HK. The rising prevalence and incidence of gout in British Columbia, Canada: population-based trends from 2000 to 2012. Semin Arthritis Rheum. 2017;46(4):451–6.CrossRefPubMed

Winnard D, Wright C, Taylor WJ, Jackson G, Te Karu L, Gow PJ, Arroll B, Thornley S, Gribben B, Dalbeth N. National prevalence of gout derived from administrative health data in Aotearoa New Zealand. Rheumatology (Oxford). 2012;51(5):901–9.CrossRef

Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and nutrition examination survey 2007-2008. Arthritis Rheum. 2011;63(10):3136–41.CrossRefPubMed

Robinson PC, Taylor WJ, Merriman TR. Systematic review of the prevalence of gout and hyperuricaemia in Australia. Intern Med J. 2012;42(9):997–1007.CrossRefPubMed

10.

Robinson PC, Taylor WJ, Dalbeth N. An observational study of gout prevalence and quality of care in a national Australian General Practice population. J Rheumatol. 2015;42(9):1702–7.CrossRefPubMed

11.

Ting K, Gill TK, Keen H, Tucker GR, Hill CL. Prevalence and associations of gout and hyperuricaemia: results from an Australian population-based study. Intern Med J. 2016;46(5):566–73.CrossRefPubMed

12.

Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, Pillinger MH, Merill J, Lee S, Prakash S, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken). 2012;64(10):1431–46.CrossRef

13.

Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J, Coyfish M, Guillo S, Jansen TL, Janssens H, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29–42.CrossRefPubMed

14.

Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Comorbidities in patients with gout prior to and following diagnosis: case-control study. Ann Rheum Dis. 2016;75(1):210–7.CrossRefPubMed

15.

Pascual E, Sivera F. Why is gout so poorly managed? Ann Rheum Dis. 2007;66(10):1269–70.CrossRefPubMedPubMedCentral

16.

Reach G. Treatment adherence in patients with gout. Joint Bone Spine. 2011;78(5):456–9.CrossRefPubMed

17.

Roddy E, Zhang W, Doherty M. Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations. Ann Rheum Dis. 2007;66(10):1311–5.CrossRefPubMedPubMedCentral

18.

Dehlin M, Ekstrom EH, Petzold M, Stromberg U, Telg G, Jacobsson LT. Factors associated with initiation and persistence of urate-lowering therapy. Arthritis Res Ther. 2017;19(1):6.CrossRefPubMedPubMedCentral

19.

Chung Y, Lu CY, Graham GG, Mant A, Day RO. Utilization of allopurinol in the Australian community. Intern Med J. 2008;38(6):388–95.CrossRefPubMed

20.

Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007-2008. Am J Med. 2012;125(7):679–87. e671CrossRefPubMed

21.

Rai SK, Burns LC, De Vera MA, Haji A, Giustini D, Choi HK. The economic burden of gout: a systematic review. Semin Arthritis Rheum. 2015;45(1):75–80.CrossRefPubMed

22.

Roddy E, Zhang W, Doherty M. Is gout associated with reduced quality of life? A case-control study. Rheumatology (Oxford). 2007;46(9):1441–4.CrossRef

23.

Government of South Australia Department of Health Population Research and Outcome Studies. The health omnibus survey (HOS) methodology. 2002, Number : 2002–04(https://health.adelaide.edu.au/pros/docs/reports/BR_2002-04_Health_Omnibus_Survey_HOS_Methodology.pdf). Accessed 29 Apr 2018.

24.

Government of South Australia Department of Health. Health Omnibus Survey (HOS) evaluation report 2006, https://health.adelaide.edu.au/pros/docs/reports/general/hos_evaluation_report.pdf. Accessed 29 Apr 2018.

25.

Australian Bureau of Statistics. Census of population and housing: socio-economic indexes for areas (SEIFA). In. Australia. http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001. Accessed 29 Apr 2018.

26.

World Health Organization: Obesity: preventing and managing the global epidemic. Report of a WHO Consultation (WHO Technical Report Series 894). 2000. http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/. Accessed 31 Jan 2018.

27.

Austalian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report: 2013. Canberra: AIHW; 2014. http://www.aihw.gov.au/publication-detail/?id=60129549469. 31 Jan 2018.

28.

Austalian Institute of Health and Welfare. National Drug Strategy Household Survey (NDSHS) code book: section 2 - use of alcohol. Canberra: Australian Data Archive; 2014. http://dataverse.ada.edu.au/file.xhtml?fileId=643&version=1.1.

29.

National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. In: Australian Guidelines. Australia: NHMRC; 2009. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ds10-alcohol.pdf. Accessed 31 Jan 2018.

30.

Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.CrossRefPubMed

31.

Gandhi SK, Salmon JW, Zhao SZ, Lambert BL, Gore PR, Conrad K. Psychometric evaluation of the 12-item short-form health survey (SF-12) in osteoarthritis and rheumatoid arthritis clinical trials. Clin Ther. 2001;23(7):1080–98.CrossRefPubMed

32.

Sanderson K, Andrews G. The SF-12 in the Australian population: cross-validation of item selection. Aust N Z J Public Health. 2002;26(4):343–5.CrossRefPubMed

33.

Australian Bureau of Statistics. National Health Survey: summary of results 1995 (4364.0). Canberra: Australian Bureau of Statistics; 1997.

34.

McAdams MA, Maynard JW, Baer AN, Kottgen A, Clipp S, Coresh J, Gelber AC. Reliability and sensitivity of the self-report of physician-diagnosed gout in the campaign against cancer and heart disease and the atherosclerosis risk in the community cohorts. J Rheumatol. 2011;38(1):135–41.CrossRefPubMed

35.

Dal Grande E, Fullerton S, Taylor AW. Reliability of self-reported health risk factors and chronic conditions questions collected using the telephone in South Australia, Australia. BMC Med Res Methodol. 2012;12:108.CrossRefPubMedPubMedCentral

36.

Wijnands JM, Viechtbauer W, Thevissen K, Arts IC, Dagnelie PC, Stehouwer CD, van der Linden S, Boonen A. Determinants of the prevalence of gout in the general population: a systematic review and meta-regression. Eur J Epidemiol. 2015;30(1):19–33.CrossRefPubMed

37.

Simmonds HA, McBride MB, Hatfield PJ, Graham R, McCaskey J, Jackson M. Polynesian women are also at risk for hyperuricaemia and gout because of a genetic defect in renal urate handling. Br J Rheumatol. 1994;33(10):932–7.CrossRefPubMed

38.

Dehghan A, Kottgen A, Yang Q, Hwang SJ, Kao WL, Rivadeneira F, Boerwinkle E, Levy D, Hofman A, Astor BC, et al. Association of three genetic loci with uric acid concentration and risk of gout: a genome-wide association study. Lancet. 2008;372(9654):1953–61.CrossRefPubMedPubMedCentral

39.

Hollis-Moffatt JE, Xu X, Dalbeth N, Merriman ME, Topless R, Waddell C, Gow PJ, Harrison AA, Highton J, Jones PB, et al. Role of the urate transporter SLC2A9 gene in susceptibility to gout in New Zealand Maori, Pacific Island, and Caucasian case-control sample sets. Arthritis Rheum. 2009;60(11):3485–92.CrossRefPubMed

40.

Phipps-Green AJ, Hollis-Moffatt JE, Dalbeth N, Merriman ME, Topless R, Gow PJ, Harrison AA, Highton J, Jones PB, Stamp LK, et al. A strong role for the ABCG2 gene in susceptibility to gout in New Zealand Pacific Island and Caucasian, but not Maori, case and control sample sets. Hum Mol Genet. 2010;19(24):4813–9.CrossRefPubMed

41.

Chou CT, Pei L, Chang DM, Lee CF, Schumacher HR, Liang MH. Prevalence of rheumatic diseases in Taiwan: a population study of urban, suburban, rural differences. J Rheumatol. 1994;21(2):302–6.PubMed

42.

Bruderer S, Bodmer M, Jick SS, Meier CR. Use of diuretics and risk of incident gout: a population-based case-control study. Arthritis Rheumatol. 2014;66(1):185–96.CrossRefPubMed

43.

Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, et al. 2015 gout classification criteria: an American College of Rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis. 2015;74(10):1789–98.CrossRefPubMedPubMedCentral

44.

Wang W, Krishnan E. Cigarette smoking is associated with a reduction in the risk of incident gout: results from the Framingham heart study original cohort. Rheumatology (Oxford). 2015;54(1):91–5.CrossRef

45.

Jeyaruban A, Soden M, Larkins S. Prevalence of comorbidities and management of gout in a tropical city in Australia. Rheumatol Int. 2016;36(12):1753–8.CrossRefPubMed

46.

Wood R, Fermer S, Ramachandran S, Baumgartner S, Morlock R. Patients with gout treated with conventional urate-lowering therapy: association with disease control, health-related quality of life, and work productivity. J Rheumatol. 2016;43(10):1897–903.CrossRefPubMed

47.

Dalbeth N, Petrie KJ, House M, Chong J, Leung W, Chegudi R, Horne A, Gamble G, McQueen FM, Taylor WJ. Illness perceptions in patients with gout and the relationship with progression of musculoskeletal disability. Arthritis Care Res (Hoboken). 2011;63(11):1605–12.CrossRef

48.

Horsburgh S, Norris P, Becket G, Arroll B, Crampton P, Cumming J, Keown S, Herbison P. Allopurinol use in a New Zealand population: prevalence and adherence. Rheumatol Int. 2014;34(7):963–70.CrossRefPubMed

49.

Riedel AA, Nelson M, Joseph-Ridge N, Wallace K, MacDonald P, Becker M. Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims. J Rheumatol. 2004;31(8):1575–81.PubMed

50.

Hill CL, Appleton SL, Black J, Hoon E, Rudd RE, Adams RJ, Gill T. Role of health literacy in self-reported musculoskeletal disorders. Arthritis. 2015;2015:607472.CrossRefPubMedPubMedCentral

51.

Walsh CP, Prior JA, Chandratre P, Belcher J, Mallen CD, Roddy E. Illness perceptions of gout patients and the use of allopurinol in primary care: baseline findings from a prospective cohort study. BMC Musculoskelet Disord. 2016;17(1):394.CrossRefPubMedPubMedCentral

52.

Duyck SD, Petrie KJ, Dalbeth N. “You don’t have to be a drinker to get gout, but it helps”: a content analysis of the depiction of gout in popular newspapers. Arthritis Care Res (Hoboken). 2016;68(11):1721–5.CrossRef

53.

Scheepers L, van Onna M, Stehouwer CDA, Singh JA, Arts ICW, Boonen A. Medication adherence among patients with gout: a systematic review and meta-analysis. Semin Arthritis Rheum. 2018;47(5):689–702.CrossRefPubMed

54.

Nguyen UD, Zhang Y, Louie-Gao Q, Niu J, Felson DT, LaValley MP, Choi HK. The obesity paradox in recurrent attacks of gout in observational studies: clarification and remedy. Arthritis Care Res (Hoboken). 2017;69(4):561–66.

55.

Roberts RL, Wallace MC, Phipps-Green AJ, Topless R, Drake JM, Tan P, Dalbeth N, Merriman TR, Stamp LK. ABCG2 loss-of-function polymorphism predicts poor response to allopurinol in patients with gout. Pharmacogenomics J. 2017;17(2):201–3.CrossRefPubMed