Prevalence of Gout Higher in Asian American Patients

Results of a cross-sectional analysis demonstrated that Asian patients living in the United States (US) were more likely to be diagnosed with gout, which was not linked to socioclinical factors, according to data published in JAMA Network Open.¹

Chio Yokose, MD, MSc

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Currently, gout is the most common inflammatory arthritis, with a growing number of patients diagnosed globally and a greater prevalence in the US compared with other Western countries. Investigators noted racial and ecological disparities in disease burden, such as a higher prevalence among Black patients when compared with White patients, which was explained by the social determinants of health as well as clinical factors.²

“No information is available among US Asian individuals, the fastest-growing racial and ethnic group in the US, but also one substantially underrepresented in US health research, or among their counterparts in other Western countries,” wrote Chio Yokose, MD, MSc, Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and colleagues.

The population-based study analysis used data from a nationally representative sample of adults in the US from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. The prevalence of gout and serum urate concentration according to race and ethnicity was evaluated using Asian patients as the primary source of data collection. Hyperuricemia was defined as a serum urate concentration of ≥7.0 mg/dL among male patients and ≥5.7 mg/dL among female patients.

Data from the United Kingdom biobank (UKBB), a prospective cohort of ≥ 500 000 residents of the UK aged 40 to 69 years at enrollment, between 2006 and 2021, were utilized to replicate the differences between White and Asian patients. Analysis was performed between December 2021 and September 2022.

Of the 22,261 patients with in the NHANES databank, the mean age was 49.8 years and 48.4% were male (n = 10,948). Between 2017 and 2018, 12.1 million individuals in the US had a gout diagnosis, with the crude prevalence increasing from 3.6% (95% confidence interval [CI], 2.8% - 4.5%) in 2011 to 2012 to 5.1% (95% CI, 4.2% - 5.9%) in 2017 to 2018 (P = .03). The trend was not significant after adjusting for age or excluding Asian patients.

During this time, age- and sex-adjusted prevalence among Asian Americans doubled from 3.3% (95% CI, 2.1% - 4.5%) to 6.6% (95% CI, 4.4% - 8.8%) (P = .007), which exceeded all other ethnic and racial groups. The age- and sex-matched adjusted odds ratio (OR) during this time was 1.61 (95% CI, 1.03-2.51) with a socioclinical factor–adjusted multivariable OR of 2.62 (95% CI, 1.59 - 4.33) for Asian vs White participants. The most recent age- and sex-adjusted gout prevalence in the US among patients aged 65 years and older was 10.0% for White patients and 14.8% for Asian patients, including 23.6% of Asian men. The serum urate concentrations similarly increased between 2011 and 2018 among Asian patients. This disparity between White and Asian patients was also exhibited in the UK Biobank.

Investigators noted that while the data from NHANES is likely to be generalizable to the entire US population, data from the UKBB may not be as representative of the general population in the UK. This may account for the lower gout prevalence in the UK compared with the US. They also noted that although they were able to analyze Asian patients in the US, the category is comprised of more than 40 subgroups. Therefore, subgroup-specific data may be beneficial.

“Gout now affects more than 12 million US adults because of an aging population and increasing prevalence among Asian individuals, which numerically surpassed all other racial and ethnic groups in 2017 to 2018,” investigators concluded. “This Asian vs White disparity does not appear to be associated with socioclinical factors.”

References

1. ^{Yokose C, McCormick N, Lu N, et al. Trends in Prevalence of Gout Among US Asian Adults, 2011-2018. JAMA Netw Open. 2023;6(4):e239501. doi:10.1001/jamanetworkopen.2023.9501}
2. ^{McCormickN,LuN,YokoseC,etal.RacialandsexdisparitiesingoutprevalenceamongUSadults.JAMANetw Open. 2022;5(8):e2226804. doi:10.1001/jamanetworkopen.2022.26804}