Comparison of Gout Outcomes in Urban, Rural Patients Show No Difference

S. Scott Sutton, PharmD

Credit: College of Pharmacy, University of South Carolina

New data demonstrated no statistically significant difference in the proportion of patients achieving target serum uric acid (sUA) levels among patients in metropolitan, micropolitan, and rural areas. The study did reveal better treatment adherence was observed in rural patients than those in urban and micropolitan areas.¹

The standard treatment for gout is urate-lowering therapy (ULT) which reduces the sUA levels (<6 mg/dL) of patients with gout. Treatment adherence in order to maintain target sUA levels is important for patients to lower their risk of disease flares.²

"Failure to achieve adequate sUA control has been associated with increased risk of kidney dysfunction, diabetes, as well as cardiovascular decline," the study stated. "Therefore, understanding sUA treatment and outcomes are critical, not just for preventing gout reoccurrence, but also to prevent or slow the progression of comorbid conditions."¹

Gout Treatment Adherence Across the Country

Investigators led by S. Scott Sutton, PharmD, of Columbia VA Health Care System, and the University of South Carolina, aimed to analyze patient outcomes related to gout treatment including, sUA measures and treatment adherence across patients in various counties.

The drug-disease cohort study consisted of 9922 patients with gout who initiated ULT. The primary outcome was the proportion of patients with sUA levels below 6 mg/dL at 1 year of follow-up.

The secondary outcome was treatment adherence, which investigators calculated using the proportion of days covered. The statistical analysis was performed using a chi-square test and adjusted logistic regression to compare the proportion of patients achieving target sUA levels and the proportion of days covered (>80%) across the 3 cohort groups.

Similar Outcomes, Varied Adherence

Most of the study population was from metropolitan areas (77.4%), followed by micropolitan (11.8%) and rural areas (10.8%). Ultimately, investigators found no statistically significant difference in the proportion of patients achieving sUA levels below 6 mg/dL among metropolitan (37.17%), micropolitan (38.9%), and rural patients (37.7%).

However, after analyzing treatment adherence, a significantly higher proportion of patients achieved 80% adherence in rural areas (55.05%) compared with those in micropolitan (51.78%) and metropolitan areas (49.92%). The study noted that adjusted regression models showed no statistically significant difference in proportions achieving target sUA levels or 80% adherence.

These findings suggest urban patients treated for gout did not have better gout outcomes compared with rural patients. Future research should consider provider-based interventions to improve outcomes.

"Shifting provider thinking toward treating gout as a chronic condition subject to similar monitoring as patients on antihypertensives could improve outcomes," investigators wrote. "In fact, studies show that with provider (nurse or pharmacist) led treatment programs, adherence to treatment significantly improves."

References:

1. Sutton SS, Magagnoli J, Cummings TH, Hardin JW. Odds of Achieving Target Serum Uric Acid Levels Among Gout Patients: The Role of Rurality in Outcomes and Treatment Adherence. J Prim Care Community Health. 2023;14:21501319231167379. doi:10.1177/21501319231167379
2. Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29-42. doi: 10.1136/annrheumdis-2016-209707