Cause‐Specific Mortality in Gout: Novel Findings of Elevated Risk of Non–Cardiovascular‐Related Deaths

• Published in: Arthritis & rheumatology (Hoboken, N.J.) Vol. 71; no. 11; pp. 1935 - 1942
• Main Authors: Vargas‐Santos, Ana Beatriz, Neogi, Tuhina, Rocha Castelar‐Pinheiro, Geraldo, Kapetanovic, Meliha C., Turkiewicz, Aleksandra
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2019
• Subjects: Aged; Aged, 80 and over; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Case-Control Studies; Cause of Death; Clinical Medicine; Comparators; Confidence intervals; Death; Dementia - epidemiology; Dementia - mortality; Dementia disorders; Diabetes Mellitus - epidemiology; Diabetes Mellitus - mortality; Diagnosis; Digestive system; Digestive System Diseases - epidemiology; Digestive System Diseases - mortality; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Gout; Gout - epidemiology; Health hazards; Health risks; Health Sciences; Heart diseases; Humans; Hälsovetenskap; Infections - epidemiology; Infections - mortality; Kidney diseases; Klinisk medicin; Lung Diseases - epidemiology; Lung Diseases - mortality; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Men; Metabolic disorders; Middle Aged; Mortality; Neoplasms - epidemiology; Neoplasms - mortality; Proportional Hazards Models; Public Health, Global Health, Social Medicine and Epidemiology; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - mortality; Reumatologi och inflammation; Rheumatology and Autoimmunity; Sweden - epidemiology; Women; Sweden
• ISSN: 2326-5191; 2326-5205
• DOI: 10.1002/art.41008

Objective To examine cause‐specific mortality beyond cardiovascular diseases (CVDs) in patients with gout compared to the general population. Methods We included all residents of Skåne (Sweden) age ≥18 years in the year 2002. Using the Skåne Healthcare Register, we identified subjects with a new diagnosis of gout (2003–2013) and matched each person with gout with 10 comparators free of gout, by age and sex. We used information on the underlying cause of death from the Swedish Cause of Death Register (through December 31, 2014) to estimate hazard ratios (HRs, with 95% confidence intervals [95% CIs]) of mortality for specific causes of death in a multi‐state Cox model, with adjustment for potential confounders. Results Among 832,258 persons, 19,497 had a new diagnosis of gout (32% women) and were matched with 194,947 comparators. Subjects with gout had higher prevalence of chronic kidney disease, metabolic disease, and CVD. Gout was associated with 17% increased hazard of all‐cause mortality overall (HR 1.17 [95% CI 1.14–1.21]), 23% in women (HR 1.23 [95% CI 1.17–1.30]), and 15% in men (HR 1.15 [95% CI 1.10–1.19]). In terms of cause‐specific mortality, the strongest associations were seen in the relationship of gout to the risk of death due to renal disease (HR 1.78 [95% CI 1.34–2.35]), diseases of the digestive system (HR 1.56 [95% 1.34–1.83]), CVD (HR 1.27 [95% CI 1.22–1.33]), infections (HR 1.20 [95% CI 1.06–1.35]), and dementia (HR 0.83 [95% CI 0.72–0.97]). Conclusion Several non‐CV causes of mortality are increased in persons with gout, emphasizing the need for improved management of comorbidities.