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The unclosing premature mortality gap in gout: a general population-based study
  1. Mark C Fisher1,
  2. Sharan K Rai1,
  3. Na Lu1,
  4. Yuqing Zhang1,2,
  5. Hyon K Choi1
  1. 1 Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Hyon K Choi, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 165, Boston, MA 02114, USA; hchoi{at}


Objective Gout, the most common inflammatory arthritis, is associated with premature mortality. Whether this mortality gap has improved over time, as observed in rheumatoid arthritis (RA), is unknown.

Methods Using an electronic medical record database representative of the UK general population, we identified incident gout cases and controls between 1999 and 2014. The gout cohort was divided based on year of diagnosis into early (1999–2006) and late (2007–2014) cohorts. We compared the mortality rates and HRs, adjusting for potential confounders between the cohorts. We conducted sensitivity analyses among patients with gout who received at least one prescription for urate-lowering therapy, which has been found to have a validity of 90%.

Results In both cohorts, patients with gout showed similar levels of excess mortality compared with their corresponding comparison cohort (ie, 29.1 vs 23.5 deaths/1000 person-years and 23.0 vs 18.8 deaths/1000 person-years in the early and late cohorts, respectively). The corresponding mortality HRs were 1.25 (95% CI 1.21 to 1.30) and 1.24 (95% CI 1.20 to 1.29), and the multivariable HRs were 1.10 (95% CI 1.06 to 1.15) and 1.09 (95% CI 1.05 to 1.13), respectively (both p values for interaction >0.72). Our sensitivity analyses showed similar findings (both p values for interaction >0.88).

Conclusions This general population-based cohort study indicates that the level of premature mortality among patients with gout remains unimproved over the past 16 years, unlike RA during the same period. This unclosing premature mortality gap calls for improved management of gout and its comorbidities.

  • Gout
  • Epidemiology
  • Arthritis

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  • Handling editor Tore K Kvien

  • Contributors Study conception and design: MCF and HKC. Acquisition, analysis and interpretation of data: all authors. Drafting of the manuscript: all authors. Critical revision of the manuscript for important intellectual content: all authors.

  • Funding This project was supported in part by National Institutes of Health (NIH) grant P60-AR-047785 and NIH grant R01-AR-065944.

  • Competing interests HKC reports grants from AstraZeneca, consulting fees from Takeda and consulting fees from Selecta outside the submitted work.

  • Ethics approval The current study was approved by the Boston University Institutional Review Board and Multicenter Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.