US veterans with gout have an excess death risk that is largely attributable to comorbidities, particularly genitourinary and digestive conditions such as chronic kidney disease and hepatic disease, a recent study finds.

Investigators matched 559,243 veterans with gout 10:1 to 5,428,760 veterans without gout by age, sex, and year of enrollment in the Veteran’s Administration. The cohort was 99% male and had a mean age of 67 years.

Patients with gout had a 9% excess risk of all-cause mortality that disappeared after adjustment for body mass index, race, smoking, and comorbidities.

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In adjusted analyses by causes of death, genitourinary diseases were significantly associated with a 50% increased risk of death, followed by digestive diseases (26%), blood disorders (20%), musculoskeletal disease (19%), skin disease (14%), infection (10%), and cardiovascular disease (7%), Ted R. Mikuls, MD, MSPH, of Veterans Affairs Nebraska-Western Iowa Health Care System in Omaha and colleagues reported in Arthritis Care & Research.

Within the genitourinary category, gout was significantly associated with a 91%, 71%, and 54% increased risk of dying from nephritis, chronic kidney disease, and acute renal failure, respectively, the investigators reported. Within the digestive diseases category, gout was significantly associated with a 51%, 43%, 13%, and 10% increased risk of dying from gastritis, hepatic disease, gastrointestinal hemorrhage, and gastrointestinal perforation, respectively.

The relationship between gout and kidney disease may be bidirectional, Dr Mikul’s team suggested, spurring a “vicious cycle” that likely contributes to the reduced survival. The relationship between gout and hepatic diseases likely reflect excess alcohol consumption or nonalcoholic fatty liver disease, they added.

In line with some previous research, gout was significantly associated with a 36% decreased risk of dying from nervous system disease (Alzheimer disease and Parkinson disease) and a 34% decreased risk of dying from mental health disorders (unspecified dementia and vascular dementia). Gout also was significantly associated with a 19%, 7%, and 4% decreased risk of death from respiratory disease, malignancy, and metabolic disease, respectively.

“Together, these findings emphasize the importance of better understanding the interplay between gout and related comorbidity as a means of providing a more holistic approach to gout management and improving long-term outcomes in this at-risk patient population,” Dr Mikul’s and colleagues wrote.

Disclosure: This research was supported by Horizon Therapeutic. Please see the original reference for a full list of disclosures.


Helget LN, England BR, Roul P, et al. Cause-specific mortality in patients with gout in the US Veterans Health Administration: a matched cohort study. Arthritis Care Res. Published online March 16, 2022. doi:10.1002/acr.24881