Comorbidity in gout at the time of first diagnosis: sex differences that may have implications for dosing of urate lowering therapy

Panagiota Drivelegka,Lennart T H Jacobsson,Anna Svärd,Mats Dehlin,Valgerdur Sigurdardottir

doi:10.1186/s13075-018-1596-x

Panagiota Drivelegka, Lennart T H Jacobsson + Show 3 more

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https://doi.org/10.1186/s13075-018-1596-x

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Abstract

BackgroundThe aim of this study is to examine the occurrence of comorbidities at the time of first diagnosis of gout compared with matched population controls, overall and by sex, as well as to examine the crude and age-standardized prevalence of these comorbidities in men and women with gout at first diagnosis.MethodsA population-based study used data from Swedish national and regional registers, including 14,113 gout patients aged ≥ 20 years, with a first recorded diagnosis of gout between 1 January 2006 and 31 December 2012, and 65,782 population controls, matched by age, sex and county. Prevalence ratios (95% confidence intervals) comparing gout cases and controls were calculated, overall and by sex. Crude and age-standardized prevalence (95% confidence interval) of all comorbidities in gout patients were calculated, to show differences between sexes, taking also the higher age at diagnosis in women into account.ResultsAll examined comorbidities were 1.2–2.5-fold more common in gout patients at diagnosis than in population controls in both sexes. Women with gout were on average 6 years older than men at first gout diagnosis and most comorbidities, including obesity and diuretic use, were or tended to be more frequent in women than in men. When standardizing for age, women had a higher prevalence of thromboembolism (6.6% vs 5.2%) and chronic obstructive pulmonary disease (3.1% vs 2.4%). Men, on the other hand, had a higher prevalence of coronary heart disease (9.4% vs 6.4%), atrial fibrillation (9.0% vs 6.0%), congestive heart failure (7.7% vs 6.6%) and stroke (4.1% vs 3.3%).ConclusionsThe occurrence of most comorbidities was significantly increased at first diagnosis of gout in both sexes. Women were older at diagnosis and had higher occurrence of most comorbidities, including obesity and diuretic use, factors that increase serum urate, and this needs to be taken into account when starting and optimizing urate lowering therapy. These sex differences were attenuated when standardizing for age and the occurrence of cardiovascular diseases was actually higher in men.

Highlights

The aim of this study is to examine the occurrence of comorbidities at the time of first diagnosis of gout compared with matched population controls, overall and by sex, as well as to examine the crude and agestandardized prevalence of these comorbidities in men and women with gout at first diagnosis
The prevalence of comorbidities when using the stricter case definition was overall similar to that in the main analyses (Additional file 2: Table S2). In this large, population-based study of patients with gout, recruited from both primary and specialized health care, we found that both comorbidities suggested to increase serum urate (SU) level and other comorbidities were more common in gout cases vs population-based controls, both overall and for men and women separately
The study includes a large number of subjects with gout and controls, which generates statistically robust estimates for the occurrence of the various comorbidities. This large, population-based study shows that all patients with gout have higher occurrence of many comorbid conditions at the time of first diagnosis, compared to matched controls from the general population

Summary

Introduction

The aim of this study is to examine the occurrence of comorbidities at the time of first diagnosis of gout compared with matched population controls, overall and by sex, as well as to examine the crude and agestandardized prevalence of these comorbidities in men and women with gout at first diagnosis. Gout has been linked with an increased occurrence of several comorbidities, which all may influence the overall effect on quality of life and increased mortality [2,3,4] Some of these comorbidities, such as use of diuretics [5, 6], renal disease [7,8,9,10,11,12,13,14], obesity [15, 16], transplantation [17,18,19,20], psoriasis [21, 22] and alcohol overconsumption [23, 24], have been suggested to increase SU levels and be part of the causal pathway for developing hyperuricemia and clinical gout. There is only limited evidence for positive associations with cerebrovascular disease [30,31,32,33] or peripheral vascular disease (PVD) [34, 35]

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