Gout in Native Hawaiian Patients in Hawai'i: Clinical Characteristics and Disparities
Celia Chang1, Andrea Siu2, Chieko Kimata2
1Washington University in St. Louis, St. Louis, Missouri.
Insights
Native Hawaiian patients with gout experience a higher disease burden, including earlier onset and more tophi, compared to White patients. They also show increased emergency department use and less access to rheumatology care.
Area of Science:
- Rheumatology
- Public Health
- Health Disparities
Background:
- Gout is a common inflammatory arthritis characterized by hyperuricemia.
- Understanding ethnic variations in gout presentation and healthcare utilization is crucial for targeted interventions.
Purpose of the Study:
- To investigate differences in clinical characteristics and healthcare utilization between Native Hawaiian and White patients diagnosed with gout.
Main Methods:
- A retrospective chart review was conducted on Native Hawaiian and White patients with gout treated between 2011 and 2017.
- Demographic data, clinical outcomes, risk factors, and emergency department visit predictors were compared using multivariable logistic regression.
Main Results:
- Native Hawaiian patients were younger at diagnosis (54.0 vs 64.0 years) with earlier onset (50.0 vs 57.0 years) and higher serum urate levels (mean 7.58 vs 6.87 mg/dL).
- Native Hawaiians presented with more tophi (median 2.00 vs 1.00) and were 2.7 times more likely to have frequent emergency department visits.
- They had lower rates of achieving therapeutic serum urate levels (≤6.0 mg/dL) and less access to rheumatology specialty care.
Conclusions:
- Native Hawaiian patients exhibit a greater gout disease burden, characterized by earlier onset, more tophi, and increased healthcare utilization, particularly emergency services.
- Lower rates of therapeutic serum urate control and rheumatology care highlight a need for culturally tailored preventive strategies.
- Further research should focus on developing culturally appropriate preventive care and management strategies for gout within the Native Hawaiian population.
Objective:
The purpose of this study was to investigate differences in clinical characteristics and health care use of Native Hawaiian and White patients with gout.
Methods:
We performed a retrospective chart review of Native Hawaiian and White patients with gout treated from 2011 to 2017 within a large health care system in Hawai'i. We compared demographic characteristics, clinical outcomes, and risk factors for gout. We used multivariable logistic regression to identify predictive factors of emergency department visits.
Results:
We identified 270 Native Hawaiian patients with gout and 239 White patients with gout. The Native Hawaiian patients were younger on average (54.0 vs 64.0 years; P < 0.0001) and had an earlier onset of disease (50.0 vs 57.0 years; P < 0.0001). Native Hawaiian patients with gout had higher mean (7.58 vs 6.87 mg/dL; P < 0.0001) and maximum (10.30 vs 9.50 mg/dL; P < 0.0001) serum urate levels compared to White patients with gout. Native Hawaiian patients with gout also had a greater number of tophi (median 2.00 vs 1.00; P < 0.0001). Native Hawaiians patients with gout were 2.7 times more likely to have frequent (≥1) emergency department visits than White patients with gout. Native Hawaiian patients with gout were less likely to have a therapeutic serum urate ≤6.0 mg/dL and had lower rates of rheumatology specialty care.
Conclusion:
Native Hawaiian patients have a higher disease burden of gout, with earlier disease onset and more tophi. Native Hawaiian patients with gout are more likely to use emergency services for gout and have lower rates of rheumatology specialty care compared to White patients. Future studies are needed to promote culturally appropriate preventive care and management of gout in Native Hawaiians.
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