Gout prevalence is on the rise among patients receiving care in Veterans Health Administration (VHA) system, as is the use of weak opioids to treat the condition, according to a study.
Using national VHA data, Lindsay N. Helget, MD, of the Veterans Affairs Nebraska-Western Iowa Health Care System and the University of Nebraska Medical Center in Omaha, and colleagues documented an increase in gout prevalence from 4.2% in 2005 to 5.8% in 2014. Gout incidence ranged from 5.8 to 7.4 cases per 1000 patient-years during the same period.
Gout prevalence was highest among men, older patients, and non-Hispanic Black patients, Dr Helget’s team reported in Arthritis Care & Research. In 2014, gout prevalence was 6.4% among men compared with 0.6% among women. Gout prevalence increased with age, ranging from a low of 0.4% among patients aged 20 to 39 years to 9.5% among those aged 80 years or older, according to the investigators. Gout prevalence was 7.0% among non-Hispanic Black patients compared with 6.0% among non-Hispanic White patients and 3.9% among both Black Hispanic patients and White Hispanic patients.
During 2014, 4.0% of all inpatient or outpatient encounters and 1.3% of hospitalizations were related to gout, the study found. Administration of urate-lowering treatment (ULT) remained stable from 2005 to 2014, with 46% of gout patients receiving ULT in 2014. During the 10-year period, prescriptions for weak opioids such as hydrocodone, codeine, and tramadol nearly doubled, from 8.4% in 2005 to 16.4% in 2014, Dr Helget and colleagues reported. The use of strong opioids such as morphine, hydromorphone, oxycodone, and fentanyl remained relatively stable (2.6% in 2005 and 3.4% in 2014).
“Efforts to improve the management of this costly chronic condition could dramatically improve patient outcomes, reduce acute health care utilization in emergency departments and hospitals, and lower health care costs in the VHA,” the authors concluded.
The study population included 326,668 patients with gout and 5,315,309 without gout. Patients with gout were significantly older than those without gout (mean 70 vs 61 years) and had a higher proportion of patients with hypertension (87% vs 51%) and diabetes mellitus (43% vs 23%).
Helget LN, England BR, Roul P, et al. Incidence, prevalence, and burden of gout in the Veterans Health Administration. Arthritis Care Res. 2021;73(9):1363-1371. doi:10.1002/acr.24339