Excess Mortality from Gout Linked to Kidney Diseases and Other Comorbidities

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Comorbid conditions—including kidney and digestive disorders, among others—are associated with an increased risk of death among patients with gout, reports a study in Arthritis Care & Research.

Using electronic health records, the researchers identified 559,243 patients with gout in the Veterans Health Administration (VHA) system from 1999 to 2015. The patients were matched for birth year, sex, and year of VHA enrollment to 5.4 million gout-free controls. Associations of gout with all-cause and cause-specific mortality were assessed by multivariable Cox regression.

Nearly all patients in the VHA sample were men; the mean age was 67 years. The analysis included 246,291 deaths in gout patients over 4.25 million patient-years and 2 million deaths in non-gout controls over 40.44 million patient-years.

On initial analysis of matched groups, patients with gout were at higher risk of death from any cause: hazard ratio (HR), 1.09. However, the association became non-significant after adjustment for comorbidity.

On analysis of cause-specific mortality, genitourinary disease was the most commonly over-represented cause of death in the gout cohort: HR, 1.50. Specific associations were noted for nephritis (HR, 1.91), chronic kidney disease (HR, 1.71), and acute renal failure (HR, 1.54). An association with urinary calculi fell short of significance.

Gout patients were also at increased risk of death from digestive diseases, especially gastritis and liver disease. Associations were also noted for mortality from blood disorders, musculoskeletal disease, skin disease, infections, and cardiovascular disease (CVD). Some causes of death were less frequent in the gout cohort, including nervous system disease, mental health disorders, respiratory disease, malignancy, external causes, and metabolic disease.

Gout is a common disorder, especially in the VHA population. Patients with gout are at elevated risk of a variety of other chronic health conditions. The increase in all-cause mortality associated with gout is typically ascribed to CVD.

In the new analysis, excess mortality among veterans with gout is related to comorbid conditions. While CVD contributes to this increased risk of death, the strongest associations are noted for genitourinary and digestive diseases. The authors highlight the need to clarify the interplay between gout and related comorbidities [Helget LN, et al. Cause-specific mortality in patients with gout in the US Veterans Health Administration: A matched cohort study. Arthritis Care Res (Hoboken), published online ahead of print March 16, 2022. doi: 10.1002/acr.24881; https://onlinelibrary.wiley.com/doi/10.1002/acr.24881].