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Cause-Specific Mortality in Patients With Gout in the US Veterans Health Administration: A Matched Cohort Study
Lindsay N Helget1, Bryant R England1, Punyasha Roul1
1Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska.
Insights
Gout patients in the Veteran's Health Administration (VHA) showed increased mortality risk, primarily linked to comorbidities. Deaths from genitourinary conditions were higher, while neurologic and mental health-related deaths were lower in gout patients.
Area of Science:
- Epidemiology
- Rheumatology
- Public Health
Background:
- Gout is a common inflammatory arthritis associated with various comorbidities.
- Understanding the mortality risk in gout patients within large healthcare systems is crucial for patient management.
Purpose of the Study:
- To compare all-cause and cause-specific mortality between gout patients and non-gout patients in the Veteran's Health Administration (VHA).
- To investigate the influence of comorbidities on mortality risk in gout patients.
Main Methods:
- A matched cohort study was conducted using VHA data from January 1999 to December 2017.
- Patients with gout (identified by ICD-9 codes) were matched 1:10 with controls based on birth year, sex, and enrollment year.
- Multivariable Cox regression was used to analyze associations between gout and mortality, adjusting for comorbidities.
Main Results:
- Gout patients (n=559,243) and controls (n=5,428,760) were predominantly male with a mean age of 67 years.
- Initially, gout patients showed an increased all-cause mortality risk (HR 1.09), which disappeared after adjusting for comorbidities (HR 0.98).
- Gout was strongly associated with increased mortality from genitourinary conditions (HR 1.50) but lower mortality from neurologic (HR 0.63) and mental health (HR 0.66) conditions.
Conclusions:
- The increased mortality risk in VHA gout patients is primarily attributed to their comorbidity burden.
- Genitourinary conditions represent the most significant cause-specific mortality risk for gout patients.
- Gout patients exhibited a reduced risk of death related to neurologic and mental health conditions.
Objective:
To compare all-cause and cause-specific mortality risk between patients with gout and patients without gout in the Veteran's Health Administration (VHA).
Methods:
We performed a matched cohort study, identifying patients with gout in the VHA from January 1999 to September 2015 based on the presence of ≥2 International Classification of Diseases, Ninth Revision codes for gout (274.X). Gout patients were matched up to 1:10 on birth year, sex, and year of VHA enrollment with patients without gout and followed until death or end of study (December 2017). Cause of death was obtained from the National Death Index. Associations of gout with all-cause and cause-specific mortality were examined using multivariable Cox regression.
Results:
Gout (n = 559,243) and matched non-gout controls (n = 5,428,760) had a mean age of 67 years and were 99% male. There were 246,291 deaths over 4,250,371 patient-years in gout patients and 2,000,000 deaths over 40,441,353 patient-years of follow-up in controls. After matching, gout patients had an increased risk of death (hazard ratio [HR] 1.09 [95% confidence interval (95% CI) 1.08-1.09]), which was no longer present after adjusting for comorbidities (HR 0.98 [95% CI 0.97-0.98]). The strongest association of gout with cause-specific mortality was observed with genitourinary conditions (HR 1.50 [95% CI 1.47-1.54]). Gout patients were at lower risk of death related to neurologic (e.g., Alzheimer's disease and Parkinson's disease) (HR 0.63 [95% CI 0.62-0.65]) and mental health (HR 0.66 [95% CI 0.65-0.68]) conditions.
Conclusion:
A higher risk of death among gout patients in the VHA was related to comorbidity burden. While deaths attributable to neurologic and mental health conditions were less frequent among gout patients, genitourinary conditions were the most overrepresented causes of death.