Gout in ambulatory care settings in the United States

To describe the ambulatory care utilization by patients with gouty arthritis (gout) in the United States using a nationally representative sample.

A cross-sectional survey design based on the ambulatory care data from the 2002 US National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey was used to examine the ambulatory care burden for gout, the characteristics of gout patients, the types of providers who see gout patients, and prescribing patterns associated with the management of gout. Weighted analyses were performed to estimate the effect of age, sex, and ethnicity on the association with gout and prescription of allopurinol.

Of the 973 million ambulatory care visits in the United States, 3.9 million were for gout. The majority of visits were for men. The average age for men with gout was lower than that for women with gout (65 vs 70 years of age). Over two-thirds of these gout visits were attended to by primary care providers, whereas visits to rheumatologists constituted only a very small proportion of these visits (1.3%). There were 2.8 million prescriptions for allopurinol, 700,000 prescriptions for nonsteroidal antiinflammatory drugs, 381,000 prescriptions for colchicine, and 341,000 prescriptions for prednisone. After adjusting for age and sex, Asians were 2.7 times more likely than Caucasians to have a gout visit. Yet these patients had lower probability of receiving allopurinol (odds ratio 0.04, 95% confidence interval 0.01-0.27).

The majority of patients with gout are seen by generalist physicians. Asian ethnicity is associated with higher number of visits for gout, but a lower frequency of allopurinol treatment.