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Risk factors for gout: a hospital-based study in urban black South Africans
M Tikly1, A Bellingan, D Lincoln
1Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
Insights
Gout is increasingly prevalent in Black South Africans due to lifestyle changes. Significant risk factors include obesity, alcohol intake, hypertension, and "white collar" occupations, particularly in men.
Area of Science:
- Rheumatology
- Epidemiology
- Public Health
Background:
- Gout was historically rare in Black South African populations.
- Changing socioeconomic conditions and lifestyles may be influencing gout prevalence.
Purpose of the Study:
- To review the clinical features of Black South African patients with gout.
- To identify significant risk factors associated with gout in this population.
Main Methods:
- Retrospective review of 90 Black South African patients with gout.
- Comparison with age- and sex-matched hospital controls.
- Case-control analysis to determine odds ratios for risk factors.
Main Results:
- Significant risk factors for gout included "white collar" occupation (OR=7.4), obesity (OR=5.3), alcohol intake (OR=3.5), and hypertension (OR=3.3).
- Obesity, "white collar" occupation, and hypertension were particularly strong predictors in men.
- Alcohol intake was the sole significant risk factor identified in women (OR=5.0).
Conclusions:
- Lifestyle and dietary changes, alongside socioeconomic improvements, are contributing to the rising prevalence of gout.
- Targeted public health interventions addressing modifiable risk factors are needed.
Abstract:
The clinical features of 90 Black South African patients with gout seen at a large urban hospital were reviewed. The mean age of the patients was 54.3 and 55.3 years for men and women, respectively. The male:female ratio was 3.3:1. All except one of the women were postmenopausal. Seventy-nine percent of patients were from the lower income groups of "blue collar" workers, old-age pensioners or the unemployed. Polyarticular gout was observed in 44.4% of the patients. Tophi were noted in 51.1% of patients but none had a history of renal calculi. Risk factors were assessed by comparing the gouty patients to an equal number of age- and sex-matched hospital controls. Case-control analysis showed a "white collar" occupation (odds ratio = 7.4), obesity (odds ratio = 5.3), alcohol intake (odds ratio = 3.5) and hypertension (odds ratio = 3.3) to be significant risk factors for gout in the overall group of both men and women. In the subgroup of men only, obesity (odds ratio = 7.8), a "white collar" occupation (odds ratio = 6.4), hypertension (odds ratio = 4.9) and alcohol intake (odds ratio = 3.5) were similarly associated with gout. In women, a history of alcohol intake was the only significant risk factor associated with gout (odds ratio = 5.0). These findings suggest that in a population where gout was previously rare, changing dietary habits and lifestyle, together with improving socioeconomic conditions are contributing significantly to the increasing prevalence of the disease.