Objective: To better understand the impact of gout on functional status, health-related quality of life, mortality and health care utilization in U.S. veterans.
Methods: All veterans seen in Veterans Integrated Service Network-13 from 10/1/96-3/31/98 received mailed surveys querying demographic characteristics; performance of activities of daily living; and HRQoL by Short-form 36 for Veterans. Administrative data included demographics; in/out-patient health care utilization; ICD-9 codes for: gout; medical comorbidities; and arthritis excluding gout: “arthritic comorbidity”; and one-year mortality. Multivariable estimates compared these between veterans with/without gout using least means squared.
Results: Subjects with gout were significantly older; retired, not married, current non-smokers; with more comorbidities. Multivariable-adjusted bodily pain was somewhat worse (49.7 vs. 47.1, p<0.01) and mental health (66.7 vs. 68.6, p<0.01) domain scores somewhat better in gout patients, both differences statistically significant but not clinically meaningful (less than threshold of 5-10 points); other SF-36 domain and summary scores and functional limitations were similar. Medical or arthritic comorbidities predicted clinically/statistically lower adjusted scores in all SF-36 domains and physical domains/PCS, respectively. Gout patients had significantly more annual primary care visits (3.5 vs. 2.7, p<0.0001) and hospitalizations (18.3% vs. 15.1%, p<0.01); fewer mental health visits (10.1% vs. 13.7%, p<0.01); and similar mortality (2.7% vs. 2.2%, p=0.23).
Conclusions: Gout is independently associated with higher medical and arthritic comorbidity, primary care and inpatient utilization. Poorer HRQoL, functional limitation and higher mortality noted in univariate analyses in gout patients were attributable to higher comorbidity and socio-demographic characteristics.
- functional status