Exploring the Gender Differences of Comorbidities in Patients With Gout

A different comorbidity profile between men and women were observed in a nationwide analysis of Spanish patients hospitalized with gout between 2005 and 2015, including differences in the prevalence of concurrent rheumatic disease, diabetes mellitus, heart failure, and obesity. Results led investigators to believe a different approach to managing female patients with gout is necessary to minimize gender blindness, according to a study published in Rheumatic and Musculoskeletal Diseases.¹

Mariano Andres, MD

Credit: Loop.org

“Gout in women has received less attention in the published literature and is notably under-represented in phenotype evaluation studies and clinical trials,” wrote Mariano Andrés, MD, Rheumatology, Dr Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain, and colleagues. “In addition, no particular notes about gout in women are given in the main guidelines and recommendations.”

Investigators emphasized that gender blindness exists in gout, a common rheumatic condition that causes inflammation, pain, and may lead to an increased risk of kidney function decline. Previous research suggested the prevalence of gout in women increases with age and brings with it more concomitant conditions and clinical manifestations hindering a gout diagnosis, potentially delaying proper management.²

The multicenter, observational, cross-sectional study evaluated patients in both public and private Spanish hospitals using basic data from 192,037 hospitalizations of those with gout. A gout diagnosis was confirmed using the International Classification of Diseases, Ninth Revision (ICD-9) coding.

Age and comorbidities were compared by sex as well as a subsequent stratification of comorbidities by age group. Any link between a comorbidity and sex was determined using multivariable logistic regression. The sex of patients with gout based on age and comorbidities was predicted via a clinical decision tree algorithm.

Results indicated women with gout (17.4% in the sample cohort) were significantly older when compared with men (73.9 years vs 64.0 years, respectively, P <.001). Gout was the primary diagnosis in 5.5% (n = 10512) of patients (85.9% of men vs 14.1% of women).

Women were more likely to exhibit chronic kidney disease (33.8% vs 25.1%), heart failure (31.8% vs 16.6%), dementia (2.1% vs 1.2%), diabetes mellites (36.2% vs 26.0%), obesity (16.3% vs 10.8%), urinary tract infection (12.0% vs 5.4%), dyslipidemia (31.8% vs 30.7%), and concurrent rheumatic disease (2.6% vs 1.4%) when compared with men.

The female sex was linked to obesity, urinary tract infection, increasing age, heart failure, and diabetes mellitus. The male sex was linked to coronary disease, obstructive respiratory diseases, and peripheral vascular disease.

Investigators noted the cross-sectional study design limited the study. Further, no treatment history or ethnicity data were available, although they assumed most patients were White of European descent. Variability in gout diagnosis may have occurred as the included data covered hundreds of physicians with presumably different approaches to gout management and diagnosis. Additionally, certain comorbidities, such as hypertension, psoriasis, anemia, and cancer, were excluded from the analysis.

However, the sample size strengthened results, as it was larger compared with similar studies. Additionally, the sample of patients was generally representative of the Spanish population and can be generalized to similar European countries. Despite using data from hospitalizations alone, the overall prevalence of comorbidities is comparable to other gout research conducted in outpatient settings.

“These results confirm the need to approach gout in women with special consideration, evaluating concurrent diseases that may impact the woman’s well-being and life expectancy, as well as the treatment choices for gout flares and urate reduction,” investigators concluded. “All these should contribute to addressing gender blindness and guaranteeing the best care from healthcare professionals.”

References

1. ^{Rodríguez-Sosa E, De Miguel E, Borrás F, Andrés M. Filling gaps in female gout: a cross-sectional study of comorbidities in 192 037 hospitalised patients. RMD Open. 2023;9(2):e003191. doi:10.1136/rmdopen-2023-003191}
2. ^{Harrold LR, Etzel CJ, Gibofsky A, et al. Sex differences in gout characteristics: tailoring care for women and men. BMC Musculoskelet Disord 2017;18:108. doi:10.1186/s12891-017-1465-9}