The new report reverses previous research suggesting that White men who consumed large amounts of gamey meat and rich foods were most at risk.
Gout is more prevalent among Black women and men compared with their White counterparts, according to a new study, but the increased prevalence appears to be tied largely to social determinants of health.
Corresponding author Natalie McCormick, PhD, of Massachusetts General Hospital, and colleagues, said that gout has traditionally been associated with wealthy White men who over-consumed gamey meat, alcohol, and rich foods.
However, the investigators noted that other demographic groups are seeing increasing rates of gout and its precursor, hyperuricemia.
“Indeed, the global frequency and disability burden of gout among women have been rising disproportionately relative to gout among men, with gout among women characterized by a higher frequency of obesity and related cardiometabolic sequalae,” they wrote.
Despite such evidence, the investigators said there has been little in the way of national data on the demographic prevalence of gout in the United States.
In a new report in JAMA Network Open, McCormick and colleagues explained the results of their analysis of the National Health and Nutrition Examination Survey. Using data from the survey spanning the years 2007-2016, the investigators tracked rates of provider-diagnosed gout and hyperuricemia and compared them to self-reported racial demographics and body mass index (BMI) scores, as well as rates of chronic kidney disease (CKD) and socioeconomic factors.
The analysis showed that the prevalence of gout was higher in men than in women, but for both sexes the rate was higher among Black survey participants than among White participants. Out of 18,693 participants, the age-standardized prevalence of gout was 3.5% in Black women and 2.0% in White women, the study showed. For men, the prevalence was 7.0% among Black men and 5.4% in White men.
“This disparity is in contrast with data from 2 decades earlier (the NHANES III), when no differences in gout prevalence were observed between Black and White adults, and parallels a disproportionate worsening of CKDand overweight and obesity among Black adults over time,” McCormick and colleagues said.
When the investigators adjusted for socioeconomic and lifestyle factors, the disparities largely diminished. When they adjusted for all risk factors, the difference became statistically null.
The investigators said social determinants of health appear to play a role even aside from any genetic predisposition to gout. They noted that CKD, a risk factor for gout, is more prevalent in Black adults than White adults, reportedly due to the APOL1 risk alleles present in African American populations.
Even so, McCormick and colleagues said, “evidence suggests that racial differences in sociodemographic, lifestyle, and clinical factors play a greater role [than APOL1], with poorer access to health care among Black individuals also contributing.”
The authors concluded that the findings of their study not only reverse previous conventional wisdom that White men were at the highest risk of gout, but also that the shift in the demographic burden could be reduced with appropriate public health and clinical interventions.
“Culturally informed interventions designed to address adiposity and kidney disease and improve diet quality while recognizing the role of poverty in gout among women could help reduce these disparities,” they concluded.
McCormick N, Lu N, Yokose C, et al. Racial and Sex Disparities in Gout Prevalence Among US Adults. JAMA Netw Open. 2022;5(8):e2226804. Published 2022 Aug 1. doi:10.1001/jamanetworkopen.2022.26804