African Americans with gout report higher emergency department and hospitalization rates and higher burden of disease than white Americans with gout. They also have worse generic mental and emotional health-related quality of life, more functional limitations and lower rates of urate-lowering treatment adherence. The quality of care they receive as measured by whether they are prescribed allopurinol is also worse.
Dr. Singh described a randomized controlled trial of a comprehensive intervention aimed at addressing these disparities conducted in 306 African American veterans at four sites in the Veterans Health Administration from 2016 to 2020.7 The intervention included culturally appropriate storytelling, information on improving adherence to gout therapy contained on a printed handout and a veteran-narrated PowerPoint, and a video. The study produced no documented improvement, even when data were broken down into a variety of factors, he said. Medical adherence went up briefly, and then down.
“We need to better understand what [factors] are modifiable and non-modifiable and then target and develop effective interventions,” Dr. Singh said.
What’s needed is to engage minorities in prospective gout studies. Also, design and test interventions in randomized controlled trials and real-world pragmatic studies, and then take the evidence back to those communities to engage them.
Larry Beresford is a medical journalist in Oakland, Calif.
References
- Fisher MC, Rai SK, Lu N, et al. The unclosing premature mortality gap in gout: A general population-based study. Ann Rheum Dis. 2017 Jul;76(7):1289–1294.
- Wang Q, Liu J, Shao R, et al. Risk and clinical outcomes of COVID-19 in patients with rheumatic diseases compared with the general population: A systematic review and meta-analysis. Rheumatol Int. 2021 May;41(5):851–861.
- Mackenzie IS, Hawkey CJ, Ford I, et al. Allopurinol versus usual care in UK patients with ischaemic heart disease (ALL-HEART): A multicentre, prospective, randomised, open-label, blinded-endpoint trial. Lancet. 2022 Oct 8;400(10359):1195–1205.
- Tardif JC, Kouz S, Waters DD, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019 Dec 26;381(26):2497–2505.
- Zhu Y, Pandya BJ, Choi HK. Comorbidities of gout and hyperuricemia in the US general population: NHANES 2007–2008. Am J Med. 2012 Jul;125(7):679–687.e1.
- Maynard JW, McAdams DeMarco MA, et al. Racial differences in gout incidence in a population-based cohort: Atherosclerosis risk in communities study. Am J Epidemiol. 2014 Mar 1;179(5):576–583.
- Singh JA, Joseph A, Baker J, et al. Storytelling to improve disease outcomes in gout (STRIDE GO): A multicenter, randomized controlled trial in African American veterans with gout. BMC Med. 2021 Nov 9; 19(1):265.