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Sex differences in gout epidemiology: evaluation and treatment
L R Harrold1, R A Yood, T R Mikuls
1Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA 01655, USA. HarroldL@ummhc.org
Insights
Women with gout are older, have more comorbidities, and receive more appropriate serum urate level monitoring. These findings highlight significant differences in gout characteristics and treatment between men and women.
Area of Science:
- Rheumatology
- Epidemiology
- Pharmacology
Background:
- Limited understanding of gout characteristics, evaluation, and treatment in women.
- Gout affects men and women differently, necessitating targeted research.
Purpose of the Study:
- To investigate epidemiological and treatment disparities between men and women with gout.
- To analyze differences in gout management within a large patient population.
Main Methods:
- Retrospective analysis of 1.4 million managed care members (1999-2003).
- Identification of adult members with gout diagnosis (≥2 ambulatory claims).
- Assessment of urate-lowering drug (ULD) initiation and serum urate monitoring.
Main Results:
- 6133 gout patients identified (4975 men, 1158 women).
- Women with gout were older, had more comorbidities, and used diuretics more frequently than men.
- Women were more likely to receive recommended serum urate level testing post-ULD initiation.
Conclusions:
- Women with gout exhibit distinct demographic and clinical profiles compared to men.
- Treatment monitoring, specifically serum urate level surveillance, appears more consistent in women.
- Further research is needed to understand and address gender-specific factors in gout management.
Background:
Little is known about the characteristics, evaluation and treatment of women with gout.
Objective:
To examine the epidemiological differences and differences in treatment between men and women in a large patient population.
Methods:
The data from approximately 1.4 million people who were members of seven managed care plans in the USA for at least 1 year between 1 January 1999 and 31 December 2003 were examined. Adult members who had pharmacy benefits and at least two ambulatory claims specifying a diagnosis of gout were identified. In addition, men and women who were new users of urate-lowering drugs (ULDs) were identified to assess adherence with recommended surveillance of serum urate levels within 6 months of initiating urate-lowering treatment.
Results:
A total of 6133 people (4975 men and 1158 women) with two or more International Classification of Disease-9 codes for gout were identified. As compared with men with gout, women were older (mean age 70 (SD 13) v 58 (SD 14), p<0.001) and had comorbidities and received diuretics more often (77% v 40%; p<0.001). Only 37% of new users of urate-lowering treatment had appropriate surveillance of serum urate levels post-initiation of urate-lowering treatment. After controlling for age, comorbidities, gout treatments, number of ULD dispensings and health plan, women were more likely (odds ratio 1.36, 95% confidence interval 1.11 to 1.67) to receive the recommended serum urate level testing.
Conclusions:
Women with gout were older, had greater comorbidities and more often used diuretics and received appropriate surveillance of serum urate levels, suggesting that the factors leading to gout as well as monitoring of treatment are very different in women and men.
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