Gout in Minority Populations Save

Gout is the most common inflammatory arthritis, but its burden is not shared equally across populations. Recent research has revealed substantial racial and ethnic disparities in both who develops gout and the care patients receive. These differences reflect not only genetic susceptibility but also the substantial influence of social determinants of health, healthcare access, and environmental exposures.1,2

Among Black Americans, gout has become more common over the past three decades. During the late 1980s, gout prevalence was similar between Black and White Americans. Today, however, Black women are 81% more likely to have gout than White women, while Black men have a 26% higher prevalence. Importantly, these differences are attributable entirely to less-favorable social and clinical factors, including obesity, poorer diet, poverty, chronic kidney disease, and diuretic use, that are themselves influenced by social and structural barriers.1

Asian Americans represent a different but equally important story. Although gout prevalence remains relatively low in many Asian countries (e.g., 1% in China), its prevalence is substantially higher among Asians living in the United States, and has been rising rapidly. Between 2011 and 2018, gout prevalence among Asian Americans doubled, from 3.3% to 6.6%, becoming the highest among major US racial and ethnic groups.2 Among Asian men aged 65 years or older, nearly one in four has gout. However, unlike the Black-White disparity, these differences persist and are even amplified after accounting for socioeconomic and clinical factors, suggesting an important role for gene–environment interactions, in which inherited urate transporter variants interact with worsening Western dietary and lifestyle factors.2

Disparities continue after gout develops. Asian and Black patients are less likely to receive recommended urate-lowering therapy, and Black patients are substantially less likely to remain on treatment.3 These gaps translate into marked differences in outcomes. Compared with White Americans, Black patients experience approximately five-fold higher rates of gout-related emergency department visits and four-fold higher rates of hospitalization directly attributable to gout.4 Asian patients also experience 30–50% higher rates of these potentially preventable acute care encounters.4  These disparities in costly, often preventable healthcare utilization far exceed the differences in gout prevalence itself, underscoring persistent gaps in gout care.

Reducing these disparities will require more than the availability of effective medications. Earlier diagnosis, broader implementation of treat-to-target urate-lowering therapy, culturally responsive care, and interventions addressing obesity, CKD, diet, and other social determinants of health are all essential. Gout is more than a painful joint condition; it is also an important challenge in delivering high-quality care to all patients.

References

1. McCormick N, Lu N, Yokose C, et al. Racial and Sex Disparities in Gout Prevalence Among US Adults. JAMA Netw Open. Aug 1 2022;5(8):e2226804. doi:10.1001/jamanetworkopen.2022.26804

2. Yokose C, McCormick N, Lu N, et al. Trends in Prevalence of Gout Among US Asian Adults, 2011-2018. JAMA Netw Open. Apr 3 2023;6(4):e239501. doi:10.1001/jamanetworkopen.2023.9501

3. Singh JA, Richman J, Yang S, Bridges SL, Saag K. Allopurinol adherence and its predictors in gout: a national cohort study in US veterans. Lancet Rheumatol. May 2020;2(5):e281–e291. doi:10.1016/S2665-9913(20)30029-1

4. Yokose C, McCormick N, Lu N, et al. Nationwide racial/ethnic disparities in US emergency department visits and hospitalizations for gout. Rheumatology (Oxford). Oct 11 2022;doi:10.1093/rheumatology/keac590