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Sex differences in gout epidemiology: evaluation and treatment
  1. L R Harrold1,
  2. R A Yood1,
  3. T R Mikuls2,
  4. S E Andrade1,
  5. J Davis1,
  6. J Fuller1,
  7. K A Chan3,
  8. D Roblin4,
  9. M A Raebel5,
  10. A Von Worley6,
  11. R Platt7,
  12. K G Saag8
  1. 1Meyers Primary Care Institute, University of Massachusetts Medical School and Fallon Foundation, Worcester, Massachusetts, USA
  2. 2University of Nebraska Medical Center and Omaha VA Medical Center, Omaha, Nebraska, USA
  3. 3Channing Laboratory and Harvard School of Public Health, Boston, Massachusetts
  4. 4Kaiser Permanente Georgia, Atlanta, Georgia, USA
  5. 5Kaiser Permanente Colorado, Denver, Colorado, USA
  6. 6Lovelace Clinic Foundation, Albuquerque, New Mexico, USA
  7. 7Harvard Pilgrim Health Care, Boston, Massachusetts
  8. 8University of Alabama, Birmingham, Alabama, USA
  1. Correspondence to:
    L R Harrold
    Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA;HarroldL{at}ummhc.org

Abstract

Background: Little is known about the characteristics, evaluation and treatment of women with gout.

Objective: To examine the epidemiological differences and differences in treatment between men and women in a large patient population.

Methods: The data from approximately 1.4 million people who were members of seven managed care plans in the USA for at least 1 year between 1 January 1999 and 31 December 2003 were examined. Adult members who had pharmacy benefits and at least two ambulatory claims specifying a diagnosis of gout were identified. In addition, men and women who were new users of urate-lowering drugs (ULDs) were identified to assess adherence with recommended surveillance of serum urate levels within 6 months of initiating urate-lowering treatment.

Results: A total of 6133 people (4975 men and 1158 women) with two or more International Classification of Disease-9 codes for gout were identified. As compared with men with gout, women were older (mean age 70 (SD 13) v 58 (SD 14), p<0.001) and had comorbidities and received diuretics more often (77% v 40%; p<0.001). Only 37% of new users of urate-lowering treatment had appropriate surveillance of serum urate levels post-initiation of urate-lowering treatment. After controlling for age, comorbidities, gout treatments, number of ULD dispensings and health plan, women were more likely (odds ratio 1.36, 95% confidence interval 1.11 to 1.67) to receive the recommended serum urate level testing.

Conclusions: Women with gout were older, had greater comorbidities and more often used diuretics and received appropriate surveillance of serum urate levels, suggesting that the factors leading to gout as well as monitoring of treatment are very different in women and men.

  • CPT, current procedural terminology
  • HMO, health maintenance organisation
  • ICD, International Classification of Disease
  • NSAIDs, non-steroidal anti-inflammatory drugs
  • ULD, urate-lowering drug

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Footnotes

  • Published Online First 27 April 2006

  • Funding: This work was supported by grants from TAP Pharmaceuticals and from the Agency for Healthcare Research and Quality (HS10391 and HS10389).

  • Competing interests: None.

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