Gout Severity, Socioeconomic Status, and Work Absence: A Cross-Sectional Study in Primary Care

To examine the association between gout severity and socioeconomic status (SES) and gout severity and work absence.

Postal questionnaires were sent to adult patients who were registered with 20 general practices and who had consultations regarding gout or had been prescribed allopurinol or colchicine in the preceding 2 years. Gout severity was defined using the following proxy measures: number of attacks, history of oligoarticular/polyarticular attacks, disease duration, and allopurinol use. SES was defined using the English index of multiple deprivation (area level) and using self-reported educational attainment (individual level). Work absence was defined as taking time off from work in the past 6 months because of gout. Adjusted odds ratios (OR_adj ; 95% confidence intervals [95% CIs]) were calculated using logistic regression models (adjusted for age, sex, body mass index, gout severity, and comorbidities).

A total of 1,184 completed questionnaires were returned. The mean age of patients was 65.6 years, and 84% were male. Not having attended further education ("further education" is defined as attendance after the statutory minimum school-leaving age of 16 years) was associated with having had ≥2 gout attacks in the last year (OR_adj 0.54 [95% CI 0.36-0.81]) and oligoarticular/polyarticular attacks (OR_adj 0.72 [95% CI 0.50-1.05]). Lower area-level deprivation was associated with fewer attacks (≥2) (OR_adj 0.71 [95% CI 0.51-0.98]). Work absence was associated with having had ≥2 gout attacks in the last year (OR_adj 2.91 [95% CI 1.22- 6.92]), oligoarticular/polyarticular attacks (OR_adj 3.10 [95% CI 1.46-6.61]), and shorter disease duration (>18 years) (OR_adj 0.13 [95% CI 0.03-0.50]).

Gout severity was associated with individual-level deprivation, countering the historic and negative perception of gout as a "rich man's disease." The association of gout severity with work absence reinforces the argument for earlier urate-lowering therapy to prevent attacks from becoming frequent and debilitating.