Abstracts Highlight Racial Disparities in Gout Prevalence, ED Visits, and Hospitalizations

Two abstracts presented at EULAR 2022 identified racial disparities in patients with gout, analyzing racial differences in the prevalence of gout and gout-related emergency department (ED) visits and hospitalizations among Black and White individuals.

Newly Emerging Racial Disparities

According to the first abstract, research published after 2010 indicates that Black individuals have a higher frequency of gout and hyperuricemia compared with White individuals in the United States, challenging the previous belief that Black individuals experience gout less often than White individuals.¹

To assess trends in racial differences in gout prevalence in the United States, researchers examined data from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and the latest decade (2007-2016), as well as data from 5 examination periods in the Atherosclerosis Risk in Communities (ARIC) study between 1988 and 2013.

Age- and sex-adjusted prevalence and odds ratios (ORs) were compared to determine the trend of racial differences in gout, testing the hypothesis that racial disparity in Black individuals emerged in the past several decades.

Researchers used a time-race interaction term to assess differences in the rate of change between the races.

The resulting analysis showed that the age- and sex-standardized prevalence of gout in NHANES increased from 2.8% (95% CI, 2.4%-3.2%) in 1988-1994 to 3.7% (95% CI, 3.2%-4.1%) in 2007-2016 among White individuals.

Although the prevalence of gout among Black individuals was lower than White individuals in 1988-1994 (2.6%; 95% CI, 2.2%-3.0%), it increased more sharply over the subsequent decades according to the time-race interaction (P for race-time interaction = .003). By 2007-2016, the prevalence of gout among Black individuals exceeded that in White individuals (5.0% [95% CI, 4.4%-5.6%]).

Corresponding age- and sex-adjusted ORs for gout in Black patients compared with White patients were 0.93 (95% CI, 0.73-1.17) in 1988-1994, increasing to 1.46 (95% CI, 1.22-1.74) in 2007-2016.

This disproportionate rise in gout prevalence among Blacks was found to be more prominent among women (OR, 1.81; 95% CI, 1.29-2.53) than men (OR, 1.26; 95% CI, 1.02-1.55) (P for race-time interactions = .002 and .01, respectively).

Researchers observed similar trends in the ARIC cohort. The OR for gout among Black individuals compared with White individuals increased from 0.82 (95% CI, 0.65-1.02) in 1987-1989 to 1.81 (95% CI, 1.49-2.19) in 2011-2013.

The findings show that gout prevalence tended to be lower in Black individuals than White individuals until the late 1980s, then rising and surpassing that of White individuals over the past several decades.

The authors note that this trend parallels a similar trend in the worsening obesity epidemic of the period, particularly in Black individuals.

Although changes in gout risk genetic profiles would not contribute to this emergence of racial differences, the authors suggested further research to clarify whether Black individuals carry genetic profiles that exacerbate the effect of lifestyle risk factors for gout.

Rates of ED Visits and Hospitalizations for Gout

The second abstract noted that in recent years, the global disease burden has been increasing for gout.² Previous research has indicated racial disparities for patients with gout, with gout prevalence appearing higher in Black patients compared with White patients.

To determine the impact of these racial disparities, researchers compared ED visits and hospitalizations with a primary discharge diagnosis of gout between Black individuals and White individuals in 2019 from the US National Emergency Department Sample and the National Inpatient Sample.

There were 160,759 ED visits and 9560 hospitalizations total among both White and Black patients with a gout diagnosis in the United States in 2019.

The mean age was higher for White patients (58.2 years) compared with Black patients (56.5 years). The proportion of men was also higher among White patients (78.0% vs 74.8%).

A larger proportion of Black patients (57.1%) reported a median household income of less than $50,000 compared with White patients (30.7%).

Notably, Black individuals had 2.7-fold higher rates of gout ED visits and 3.2-fold higher rates of gout hospitalizations than White individuals, after adjusting for age, sex, payer, region, and household income.

Black women had 3.4-fold higher rates of ED visits and 4.0-fold higher rates of hospitalizations for gout compared with White women, higher than the respective rates found for men, 2.5 and 2.8.

Although mean costs for ED visits were similar for both groups, hospitalizations were more costly for Black patients (adjusted difference, $1055.3; 95% CI, $553.1-$1557.5).

Black patients also experienced longer durations of ED visits and hospitalizations compared with White patients.

According to the authors, these findings indicate that there is a significant disparity among Black and White individuals in gout-related ED visits and hospitalizations, as both were 3 times higher for Black patients than White patients. These disparities were particularly prominent in women.

The authors called for improved primary prevention and gout care to address suboptimal care and costly health care utilization.

References

1. McCormick N, Lu L, Yokose C, et al. Identifying the new emergence of racial disparities in gout over the past 3 decades—US national survey and prospective cohort data. Presented at: EULAR 2022; June 1-4, 2022; Copenhagen, Denmark. Abstract POS1443.

2. Yokose C, McCormick N, Lu N, et al. Triple the rate of emergency room visits and hospitalizations for gout among US blacks vs whites—2019 nationwide analysis. Presented at: EULAR 2022; June 1-4, 2022; Copenhagen, Denmark. Abstract POS1171.