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Unique Considerations for the Management of Gout in the Hmong Population: Examining Tertiary Encounters at a Large
Alison Lerman1, Elie Gertner2, Terese A DeFor3
1Regions Hospital, Saint Paul, Minnesota, and University of Minnesota, Minneapolis.
Insights
Hmong patients with gout are younger but have worse kidney function and are less likely to use preventive care. Targeted, culturally sensitive interventions are crucial for managing gout and related conditions in this population.
Area of Science:
- Rheumatology
- Nephrology
- Public Health
Background:
- Gout affects diverse populations, with varying clinical presentations and outcomes.
- Understanding demographic and clinical disparities in gout management is essential for equitable healthcare.
- The Hmong population presents unique challenges in accessing and utilizing preventive care for chronic conditions.
Purpose of the Study:
- To compare demographic characteristics, healthcare encounters, comorbidities, and clinical outcomes of Hmong and non-Hmong patients diagnosed with gout.
- To identify specific differences in disease management and healthcare utilization between these two patient groups.
- To inform the development of culturally tailored interventions for gout management in the Hmong community.
Main Methods:
- A retrospective chart review was conducted for inpatient encounters between 2014 and 2017.
- Data were analyzed comparing Hmong and non-Hmong patients diagnosed with acute or chronic gout.
- Key metrics included demographics, comorbidities, renal function, care utilization patterns, and medication use.
Main Results:
- Hmong gout patients were, on average, 11 years younger than non-Hmong patients.
- Despite similar rates of hypertension, diabetes mellitus, and heart disease, Hmong patients exhibited significantly worse renal function (e.g., higher odds of chronic kidney disease, elevated creatinine, lower GFR).
- Hmong patients were more likely to use emergency care, less likely to use preventive gout medications prior to admission, and had longer hospital stays.
Conclusions:
- Hmong gout patients present with poorer renal function and different healthcare utilization patterns compared to non-Hmong patients, even at younger ages.
- There is a critical need for culturally appropriate preventive care strategies for gout and associated conditions (diabetes, hypertension, heart disease, kidney disease) within the Hmong population.
- Targeted public health initiatives and tertiary care interventions are necessary to address these disparities and improve outcomes.
Objective:
To evaluate demographic characteristics, care encounters, comorbidities, and clinical differences in Hmong and non-Hmong patients with gout.
Methods:
Using retrospective chart review, all inpatient encounters (Hmong versus non-Hmong) were reviewed from 2014 to 2017. Acute or chronic gout was the primary or secondary diagnosis for the encounter.
Results:
Hmong gout patients were on average 11 years younger than non-Hmong patients, but after adjustment for age, sex, and type of encounter, they had similar rates of hypertension, diabetes mellitus, and heart disease. Hmong patients had significantly decreased renal function at the time of presentation; the odds ratio of chronic kidney disease for Hmong patients was 2.33 versus 1.48 for non-Hmong patients (P < 0.05), the mean creatinine level was 3.3 mg/dl versus 2.0 mg/dl (β = 1.35, P < 0.001), and the glomerular filtration rate was 44.8 ml/minute versus 49.3 ml/minute (β = -6.95, P < 0.001). Hmong gout patients were more likely to use emergency care versus elective or urgent care, they were less likely to be using medications for the treatment of gout prior to admission (32.3% versus 58.2%), and the length of hospital stay was increased (8.8 versus 5.2 days; P < 0.05).
Conclusion:
Hmong gout patients who had a tertiary care encounter were 11 years younger than non-Hmong patients with similar rates of comorbidities but had worse renal function despite the age differences. They were more likely to use emergency services, to be insured through Medicaid, and not to use preventive medications for gout prior to their encounter. Intensive efforts are needed in the Hmong population for culturally appropriate preventive care management of gout along with diabetes mellitus, hypertension, heart disease, and kidney disease.
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