Abstract
BackgroundGout 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.MethodsData 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.ResultsSelf-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.ConclusionsDespite 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.
Highlights
The estimated prevalence of gout in 2008, adjusted to the age by gender distribution of the 2015 population sample, was 6.3%, indicating a strong consistency in prevalence estimates over time
Higher body mass index (BMI) was the most important predictor of treatment continuation (p = 0.015). This 2015 representative population-based study demonstrated a high prevalence of self-reported, medically diagnosed gout (6.8%, 95% CI 5.8, 7.9) in the South Australian population aged 25 and over
The relatively slight increase in gout prevalence since 2008 appears to be attributable to changes in the age-gender distribution of the South Australian population over that time. These estimates of gout prevalence are comparable to an estimate of 5.2%, in individuals 18 years and over, from the North West Adelaide Health Study cohort weighted to the South Australian estimated resident population of
Summary
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. The burden of gout remains substantial with an increasing prevalence estimated in most developed countries, in men and postmenopausal women [2,3,4]. True estimates of the prevalence of gout have been difficult to determine, with a wide range of estimates depending on the methodology, population and data source. A systematic review of gout prevalence in Australia demonstrated increasing prevalence comparable to that reported in the international data [9]. Within Australia, estimates have varied from 1.5% in a nationwide Australian primary care population study [10] to 5.2% in a recent South Australian population-based cohort study [11]
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