Zachary Bowen-Davies1, Sara Muller1, Christian D Mallen1, Richard A Hayward1, Edward Roddy2. 1. Research Institute for Primary Care & Health Sciences, Keele University, UK. 2. Research Institute for Primary Care & Health Sciences, Keele University, Keele UK, and Haywood Academic Rheumatology Centre, Haywood Hospital, UK.
Abstract
OBJECTIVE: To examine the association between gout severity and socioeconomic status (SES) and gout severity and work absence. METHODS: Postal questionnaires were sent to adult patients who were registered with 20 general practices and who had consultations regarding gout or had been prescribed allopurinol or colchicine in the preceding 2 years. Gout severity was defined using the following proxy measures: number of attacks, history of oligoarticular/polyarticular attacks, disease duration, and allopurinol use. SES was defined using the English index of multiple deprivation (area level) and using self-reported educational attainment (individual level). Work absence was defined as taking time off from work in the past 6 months because of gout. Adjusted odds ratios (ORadj ; 95% confidence intervals [95% CIs]) were calculated using logistic regression models (adjusted for age, sex, body mass index, gout severity, and comorbidities). RESULTS: A total of 1,184 completed questionnaires were returned. The mean age of patients was 65.6 years, and 84% were male. Not having attended further education ("further education" is defined as attendance after the statutory minimum school-leaving age of 16 years) was associated with having had ≥2 gout attacks in the last year (ORadj 0.54 [95% CI 0.36-0.81]) and oligoarticular/polyarticular attacks (ORadj 0.72 [95% CI 0.50-1.05]). Lower area-level deprivation was associated with fewer attacks (≥2) (ORadj 0.71 [95% CI 0.51-0.98]). Work absence was associated with having had ≥2 gout attacks in the last year (ORadj 2.91 [95% CI 1.22- 6.92]), oligoarticular/polyarticular attacks (ORadj 3.10 [95% CI 1.46-6.61]), and shorter disease duration (>18 years) (ORadj 0.13 [95% CI 0.03-0.50]). CONCLUSION: Gout severity was associated with individual-level deprivation, countering the historic and negative perception of gout as a "rich man's disease." The association of gout severity with work absence reinforces the argument for earlier urate-lowering therapy to prevent attacks from becoming frequent and debilitating.
OBJECTIVE: To examine the association between gout severity and socioeconomic status (SES) and gout severity and work absence. METHODS: Postal questionnaires were sent to adult patients who were registered with 20 general practices and who had consultations regarding gout or had been prescribed allopurinol or colchicine in the preceding 2 years. Gout severity was defined using the following proxy measures: number of attacks, history of oligoarticular/polyarticular attacks, disease duration, and allopurinol use. SES was defined using the English index of multiple deprivation (area level) and using self-reported educational attainment (individual level). Work absence was defined as taking time off from work in the past 6 months because of gout. Adjusted odds ratios (ORadj ; 95% confidence intervals [95% CIs]) were calculated using logistic regression models (adjusted for age, sex, body mass index, gout severity, and comorbidities). RESULTS: A total of 1,184 completed questionnaires were returned. The mean age of patients was 65.6 years, and 84% were male. Not having attended further education ("further education" is defined as attendance after the statutory minimum school-leaving age of 16 years) was associated with having had ≥2 gout attacks in the last year (ORadj 0.54 [95% CI 0.36-0.81]) and oligoarticular/polyarticular attacks (ORadj 0.72 [95% CI 0.50-1.05]). Lower area-level deprivation was associated with fewer attacks (≥2) (ORadj 0.71 [95% CI 0.51-0.98]). Work absence was associated with having had ≥2 gout attacks in the last year (ORadj 2.91 [95% CI 1.22- 6.92]), oligoarticular/polyarticular attacks (ORadj 3.10 [95% CI 1.46-6.61]), and shorter disease duration (>18 years) (ORadj 0.13 [95% CI 0.03-0.50]). CONCLUSION: Gout severity was associated with individual-level deprivation, countering the historic and negative perception of gout as a "rich man's disease." The association of gout severity with work absence reinforces the argument for earlier urate-lowering therapy to prevent attacks from becoming frequent and debilitating.