Sex differences in gout epidemiology: evaluation and treatment

Harrold, Leslie R.; Yood, Robert A.; Mikuls, Ted R.; Andrade, Susan E.; Davis, Judith A.; Fuller, Jonathan; Chan, K. Arnold; Roblin, Douglas W.; Raebel, Marsha A.; Worley, Ann Von; Platt, Richard; Saag, Kenneth G.

doi:10.1136/ard.2006.051649

Cited by 141 publications

(139 citation statements)

References 16 publications

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“…Similarly, we found that 24% of patients received uric acid monitoring within 6 months of new allopurinol prescription, and 2 studies in managed care plans found analogous rates of 37% (17) and 13% (18). The former study found that women were more likely than men to receive serum urate monitoring (17), implying that quality of gout care may vary by sex.…”

Section: Discussionmentioning

confidence: 97%

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Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

174

109

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Objective. To examine evidence-based quality indicators (QIs) in US veterans with gout diagnosis, and to examine the effect of demographics, heath care utilization/access, comorbid conditions, or physican characteristics as predictors of quality of gout care. Methods. Using the Minneapolis Veterans Affairs electronic medical record system, we identified a cohort of veterans receiving medication to treat gout between January 1, 1999 and December 31, 2003, and evaluated 3 recently published evidence-based QIs for gout management: QI 1 ‫؍‬ allopurinol dose <300 mg in gout patients with renal insufficiency, QI 2 ‫؍‬ uric acid check within 6 months of starting a new allopurinol prescription, and QI 3 ‫؍‬ complete blood count and creatine kinase check every 6 months for gout patients receiving prolonged colchicine therapy. We calculated the proportion of patients whose therapy adhered to each QI and to all applicable indicators (overall physician adherence). Logistic regression analysis examined association of overall physician adherence with sociodemographics, health care utilization, comorbidity, and provider characteristics. Results. Of 3,658 patients with a diagnosis of gout, 663 patients qualified for examination of >1 QI. Of these 663 patients, therapy in only 144 (22%) adhered to all applicable QIs; 59 (78%) of 76 adhered to QI 1, 155 (24%) of 643 adhered to QI 2, and 18 (35%) of 52 adhered to QI 3. Overall physician adherence to QIs was significantly lower in older veterans and in those with more inpatient visits per year, but was higher in those with more primary care visits or more health care providers. Conclusion. Suboptimal physician adherence to QIs was seen for all 3 QIs tested in this cohort of veterans with gout. These findings can guide quality improvement efforts.

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Section: Discussionmentioning

confidence: 97%

“…Mikuls et al examined 3 QIs in the UK General Practitioner Research Database (UKGPRD) and found low (25-57%) physician adherence (16). Studies in US health plans have found gaps in quality care for gout (17,18). It is unknown whether care provided to US veterans with gout meets these minimum quality standards.…”

Section: Introductionmentioning

confidence: 99%

Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

174

109

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“…Studies in the general medical population have shown a higher risk for gout in older postmenopausal women, as well as women with CKD. [23][24][25] An effect of estrogen to reduce uric acid levels needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

Association of Incident Gout and Mortality in Dialysis Patients

Cohen

Kimmel

Neff³

et al. 2008

Journal of the American Society of Nephrology

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Previous studies have shown that gout is associated with an increased risk for cardiovascular mortality in the general population, but this has not been well studied in patients with ESRD. In this study, the incidence of gout and its association with mortality was evaluated in 259,209 patients in the United States Renal Data System. Overall, the incidence of gout in the first year of dialysis was 5% and in the first 5 yr was 15.4%. Independent risk factors for gout in adjusted analyses included black race, older age, female gender, hypertension, ischemic heart disease, congestive heart failure, and alcohol use. Factors associated with a lower risk for gout included a history of diabetes, smoking, and peripheral vascular disease. Time-dependent Cox regression analysis suggested that an episode of gout was independently associated with a 1.5-fold increase in mortality risk (adjusted hazard ratio 1.49; 95% confidence interval 1.43 to 1.55). The mechanisms underlying this association require further study.

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“…В сред-нем дебют подагры у них развивался спустя всего 3,7 [2,3; 6,0] года после прекращения менструаций. Обсуждение К настоящему времени опубликовано всего несколь-ко исследований, посвященных анализу половых различий факторов риска развития гиперурикемии и подагры [5,8,10]. Общим для всех этих исследований был значительно больший средний возраст больных подагрой женщин, что во многом предопределяло и большую частоту выявления у них некоторых факторов риска гиперурикемии и подаг-ры.…”

Section: результатыunclassified