Sex differences in gout epidemiology: evaluation and treatment

被引:111
作者
Harrold, L. R.
Yood, R. A.
Mikuls, T. R.
Andrade, S. E.
Davis, J.
Fuller, J.
Chan, K. A.
Roblin, D.
Raebel, M. A.
Von Worley, A.
Platt, R.
Saag, K. G.
机构
[1] Univ Massachusetts, Sch Med, Dept Med, Meyers Primary Care Inst, Worcester, MA 01655 USA
[2] Fallon Fdn, Worcester, MA USA
[3] Univ Nebraska, Med Ctr, Lincoln, NE 68583 USA
[4] Omaha VA Med Ctr, Omaha, NE USA
[5] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA
[6] Channing Labs, Boston, MA 02115 USA
[7] Kaiser Permanente, Atlanta, GA USA
[8] Kaiser Permanente, Denver, CO USA
[9] Lovelace Clin Fdn, Albuquerque, NM USA
[10] Harvard Univ, Harvard Pilgrim Hlth Care, Boston, MA 02115 USA
[11] Univ Alabama Birmingham, Birmingham, AL 35233 USA
关键词
D O I
10.1136/ard.2006.051649
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Little is known about the characteristics, evaluation and treatment of women with gout. Objective: To examine the epidemiological differences and differences in treatment between men and women in a large patient population. Methods: The data from approximately 1.4 million people who were members of seven managed care plans in the USA for at least 1 year between 1 January 1999 and 31 December 2003 were examined. Adult members who had pharmacy benefits and at least two ambulatory claims specifying a diagnosis of gout were identified. In addition, men and women who were new users of urate-lowering drugs (ULDs) were identified to assess adherence with recommended surveillance of serum urate levels within 6 months of initiating urate-lowering treatment. Results: A total of 6133 people (4975 men and 1158 women) with two or more International Classification of Disease-9 codes for gout were identified. As compared with men with gout, women were older (mean age 70 (SD 13) v 58 (SD 14), p < 0.001) and had comorbidities and received diuretics more often (77% v 40%; p < 0.001). Only 37% of new users of urate-lowering treatment had appropriate surveillance of serum urate levels post-initiation of urate-lowering treatment. After controlling for age, comorbidities, gout treatments, number of ULD dispensings and health plan, women were more likely (odds ratio 1.36, 95% confidence interval 1.11 to 1.67) to receive the recommended serum urate level testing. Conclusions: Women with gout were older, had greater comorbidities and more often used diuretics and received appropriate surveillance of serum urate levels, suggesting that the factors leading to gout as well as monitoring of treatment are very different in women and men.
引用
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页码:1368 / 1372
页数:5
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