Gout Increases Risk of COVID-19-Related Death in Women

Data from a UK Biobank cohort suggest that gout is not only a risk factor for COVID-19-related death, but that risk increases in women with gout, independent of metabolic comorbidities, according to a study published in The Lancet.¹

The UK Biobank, which contains 500,000 volunteers aged 49-86 years of age, included data from 15,871 patients with gout. COVID-19 diagnosis was defined as those with a positive SARS-CoV-2 test or ICD-10 code for confirmed or probable COVID-19. Gout was determined by self-reported gout, hospital-diagnosed gout, and those receiving allopurinol or sulfinpyrazone.

Multivariable-adjusted logistic regression was used to assess the association in 4 case-controlled datasets. Analysis A determined any association between gout and COVID-19 diagnosis in a population-based cohort (16,898 patients and 442,939 controls); analysis B determined any association between gout and COVID-19-related deaths in participants diagnosed with COVID-19; analysis C focused on associations between gout and COVID-19-related deaths in a population-based group; and analysis D tested for any association within the subset of the UK Biobank with data relating to colchicine and urate-lowering therapy prescriptions and the risk of COVID-19-related death for patients with gout.

Models 1 and 2 adjusted for age, ethnicity, BMI, sex, smoking status, and Townsend deprivation index, with Model 2 also adjusting for 16 additional comorbidities of gout and risk factors for COVID-19 death.

Of the 459,837 participants included in the population-based cohort, 15,871 were diagnosed with gout. Between March 2020 and March 2021, 0.9% of patients with gout died due to COVID-19 compared with only 0.2% of controls. Additionally, patients who died had a higher percentage of metabolic-based diseases, such as chronic kidney disease (19.1%) and diabetes (30.7%) when compared with controls (3.2% and 7.3%, respectively).

Gout was associated with COVID-19-related death in the entire cohort (1.29, 1.06–1.56), with women experiencing an increased risk (1.98, 1.34–2.94) when compared with men (1.16, 0.93–1.45) (1.3% vs 0.8%, respectively). Additionally, women with gout had a higher number of comorbidities than men, while men had a higher number in the entire cohort.

No significant differences were seen in the risk of COVID-19-related death regarding urate-lowering therapy or colchicine treatment.

COVID-19 diagnosis was significantly higher in patients who were not vaccinated (1.21, 1.11–1.30) when compared with the vaccinated cohort (1.09, 0.65–1.85).

Data may not be generalizable as most patients were middle-aged White British patients from the UK. There is also a possibility of unidentified COVID-19-related deaths. Another limitation is that before August 2020, Public Health England had listed cause of death as COVID-19 if patients had ever received a positive test result, thus some of these deaths are inevitably not related to COVID-19. However, the organization estimates 96% accuracy. Additionally, disease activity, individual behavior modification, and medication adherence were not assessed.

“We found an increased risk of COVID-19-related death in people with gout, with a greater burden in women than men,” investigators concluded. “Understanding the drivers of this increased risk in women with gout warrants further investigation in larger datasets.”

Reference:

Topless RK, Gaffo A, Stamp LK, Robinson PC, Dalbeth N, Merriman TR. Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study. Lancet Rheumatol. 2022;4(4):e274-e281. doi:10.1016/S2665-9913(21)00401-X