Gout is the most common inflammatory arthritis worldwide. In addition to pain and disability, gout patients are at an increased risk of developing various complications (including cardiovascular disease, diabetes, and kidney disease) and premature death. Research has shown that gout care continues to be suboptimal, and that patients’ increased risk of premature death has not improved in past decades. Moreover, there has been a recent rise in opioid use among gout patients. Despite these worrisome trends, more recent data on the risk of death among gout patients are not available, including cause-specific data. This study aims to provide updated estimates on the risk of premature death among gout patients, including quantification of this risk due to different causes as well as among pertinent subgroups defined by age, sex, and race/ethnicity. Moreover, this study aims to quantify the mediating role that certain medications (e.g., opioids) may play in the risk of premature death among gout patients. Achieving this will benefit people living with gout, as it can help us learn about any ongoing premature risk of death, understand subgroups who are at particular risk, and shed light on medications which may be exacerbating this risk, thereby allowing for preventive measures and better patient care.
Gout is the most common inflammatory arthritis, and its incidence, prevalence, and disability burden have risen worldwide for decades. This growing disease burden is further complicated by a high level of cardiovascular-kidney-metabolic comorbidities, including hypertension, type 2 diabetes, chronic kidney disease, and heart failure. More recently, certain neuropsychiatric complications of gout (i.e., depression and anxiety) have also been recognized. This modern gout epidemic combined with suboptimal gout care have contributed to the recent rise in opioid use in gout patients. In addition to this increased comorbidity burden, people with gout experience a higher risk of premature all-cause mortality, and this excess risk was shown to be unchanged from 1999-2014. However, updated large-scale analyses of this premature mortality risk are urgently needed, including studies of cause-specific mortality. Moreover, population-level studies examining trends in comorbidity onset as well as key medication use would be valuable for improving care for gout patients, especially for those early in the disease course. Through this project, we will assess temporal trends in premature all-cause and cause-specific mortality among adults with gout from 1997-2023; moreover, we will assess temporal trends in the risk of selected cardiovascular-kidney-metabolic and neuropsychiatric comorbidities. We will compare these estimates with those from two related conditions, type 2 diabetes (a metabolic disease with several therapeutic and management advances [positive control exposure]) and osteoarthritis (another form of arthritis without comparable advances [negative control exposure]). Finally, we will quantify the mediating role of key medications (e.g., opioids) in the association between gout and premature mortality. This research will benefit people living with gout, as it can help elucidate any sustained premature mortality gap, understand subgroups who are at particular risk, and understand the role that key medications may play in exacerbating this risk, thereby allowing for preventive measures and better patient care.
Premature mortality trends among those with gout (primary exposure of interest), type 2 diabetes (T2D; metabolic disease comparator and positive control exposure), and osteoarthritis (OA; arthritis comparator and negative control exposure)
Excess comorbidity trends among those with gout (primary exposure of interest), T2D (metabolic condition comparator and positive control exposure), and OA (arthritis comparator and negative control exposure)
Medication use trends among those with gout
Proportion of premature mortality risk among those with gout that is mediated by NSAID and opioid use
Hyon Choi - Chief Investigator - Arthritis Research Canada
Hyon Choi - Corresponding Applicant - Arthritis Research Canada
Mary De Vera - Collaborator - University Of British Columbia
Na Lu - Collaborator - Arthritis Research Canada
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation