Lindsay N Helget1,2, Bryant R England1,2, Punyasha Roul1,2, Harlan Sayles2,3, Alison D Petro1,2, Tuhina Neogi4, James R O'Dell1,2, Ted R Mikuls1,2. 1. Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE. 2. Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. 3. Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE. 4. Boston University School of Medicine, Boston, MA.
Abstract
OBJECTIVE: Compare all-cause and cause-specific mortality risk between gout and non-gout patients in the Veteran's Health Administration (VHA). METHODS: We performed a matched cohort study, identifying patients with gout in the VHA from 1/1999-9/2015 based on the presence of ≥2 ICD-9 codes for gout (274.X). Gout patients were matched up to 1:10 on birth year, sex, and year of VHA enrollment with non-gout patients and followed until death or end-of-study (12/2017). Cause of death was obtained from the National Death Index. Associations of gout with all-cause and cause-specific mortality were examined using multivariable Cox regression. RESULTS: Gout (n=559,243) and matched non-gout controls (n=5,428,760) had a mean age of 67 years and were 99% male. There were 246,291 deaths over 4,250,371 patient-years in gout patients and 2,000,000 deaths over 40,441,353 patient-years of follow-up in controls. After matching, gout patients had an increased risk of death (HR 1.09; 95% CI 1.08-1.09) which was no longer present after adjusting for comorbidities (HR 0.98; 95% CI 0.97-0.98). The strongest association of gout with cause-specific mortality was observed with genitourinary conditions (HR 1.50; 95% CI 1.47-1.54). Gout patients were at lower risk of death related to neurologic (e.g., Alzheimer's, Parkinson's) (HR 0.63; 95% CI 0.62-0.65) and mental health (HR 0.66; 95% CI 0.65-0.68) conditions. CONCLUSION: A higher risk of death among gout patients in the VHA was related to comorbidity burden. While deaths attributable to neurologic and mental health conditions were less frequent among gout patients, genitourinary conditions were the most overrepresented causes of death. This article is protected by copyright. All rights reserved.
OBJECTIVE: Compare all-cause and cause-specific mortality risk between gout and non-gout patients in the Veteran's Health Administration (VHA). METHODS: We performed a matched cohort study, identifying patients with gout in the VHA from 1/1999-9/2015 based on the presence of ≥2 ICD-9 codes for gout (274.X). Gout patients were matched up to 1:10 on birth year, sex, and year of VHA enrollment with non-gout patients and followed until death or end-of-study (12/2017). Cause of death was obtained from the National Death Index. Associations of gout with all-cause and cause-specific mortality were examined using multivariable Cox regression. RESULTS: Gout (n=559,243) and matched non-gout controls (n=5,428,760) had a mean age of 67 years and were 99% male. There were 246,291 deaths over 4,250,371 patient-years in gout patients and 2,000,000 deaths over 40,441,353 patient-years of follow-up in controls. After matching, gout patients had an increased risk of death (HR 1.09; 95% CI 1.08-1.09) which was no longer present after adjusting for comorbidities (HR 0.98; 95% CI 0.97-0.98). The strongest association of gout with cause-specific mortality was observed with genitourinary conditions (HR 1.50; 95% CI 1.47-1.54). Gout patients were at lower risk of death related to neurologic (e.g., Alzheimer's, Parkinson's) (HR 0.63; 95% CI 0.62-0.65) and mental health (HR 0.66; 95% CI 0.65-0.68) conditions. CONCLUSION: A higher risk of death among gout patients in the VHA was related to comorbidity burden. While deaths attributable to neurologic and mental health conditions were less frequent among gout patients, genitourinary conditions were the most overrepresented causes of death. This article is protected by copyright. All rights reserved.
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