Singh Jasvinder A, Bharat Aseem, Khanna Dinesh, Aquino-Beaton Cleopatra, Persselin Jay E, Duffy Erin, Elashoff David, Khanna Puja P
Medicine Service, Birmingham VA Medical Center
Department of Medicine, School of Medicine.
Rheumatology (Oxford). 2017 Jan;56(1):103-112. doi: 10.1093/rheumatology/kew356. Epub 2016 Oct 25.
To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout.
In a 9-month prospective cohort multicentre study, patients with gout self-reported race, dichotomized as Caucasian or African American (others excluded). We calculated HRQOL/function scores adjusted for age, study site and college education for Short Form-36 (SF-36; generic HRQOL), Gout Impact Scale (GIS; disease-specific HRQOL) and HAQ-disability index (HAQ-DI; functional ability). Longitudinally adjusted scores were computed using multivariable mixed-effect regression models with a random patient effect and fixed sequential visit effect (3-monthly visits).
Compared with Caucasians (n = 107), African Americans (n = 60) with gout were younger (61.1 vs 67.3 years) and had higher median baseline serum urate (9.0 vs 7.9 mg/dl) (P < 0.01). African Americans with gout had worse HRQOL scores on three SF-36 domains, the mental component summary (MCS) and two of the five GIS scales than Caucasians [mean (se); P ⩽ 0.02 for all]: SF-36 mental health, 39.7 (1.1) vs 45.2 (0.9); SF-36 role emotional, 42.1 (4.2) vs 51.4 (4.2); SF-36 social functioning, 36.0 (1.1) vs 40.0 (0.9) (P = 0.04); SF-36 MCS, 43.2 (3.1) vs 50.0 (3.2); GIS unmet treatment need, 37.6 (1.6) vs 31.5 (1.4); and GIS concern during attacks, 53.3 (3.7) vs 47.4 (3.7). Differences between the respective HAQ-DI total scores were not statistically significant; 0.98 (0.1) vs 0.80 (1.0) (P = 0.11). Racial differences in SF-36 mental health, role emotional and MCS scales exceeded, and for HAQ-DI approached, the minimal clinically important difference thresholds.
African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes.
比较痛风患者按种族划分的健康相关生活质量（HRQOL）和功能能力。
在一项为期9个月的前瞻性队列多中心研究中，痛风患者自行报告种族，分为白种人或非裔美国人（排除其他种族）。我们计算了经年龄、研究地点和大学教育调整后的HRQOL/功能评分，用于简短健康调查问卷36项版本（SF - 36；一般健康相关生活质量）、痛风影响量表（GIS；疾病特异性健康相关生活质量）和健康评估问卷残疾指数（HAQ - DI；功能能力）。使用具有随机患者效应和固定顺序访视效应（每3个月访视一次）的多变量混合效应回归模型计算纵向调整后的评分。
与白种人（n = 107）相比，患有痛风的非裔美国人（n = 60）更年轻（61.1岁对67.3岁），且基线血清尿酸中位数更高（9.0mg/dl对7.9mg/dl）（P < 0.01）。患有痛风的非裔美国人在SF - 36的三个领域、心理成分汇总（MCS）以及五个GIS量表中的两个量表上的健康相关生活质量评分比白种人差[均值（标准误）；所有P值均≤0.02]：SF - 36心理健康，39.7（1.1）对45.2（0.9）；SF - 36情感角色，42.1（4.2）对51.4（4.2）；SF - 36社会功能，36.0（1.1）对40.0（0.9）（P = 0.04）；SF - 36 MCS，43.2（3.1）对50.0（3.2）；GIS未满足的治疗需求，37.6（1.6）对31.5（1.4）；以及GIS发作期间的担忧，53.3（3.7）对47.4（3.7）。各自HAQ - DI总分之间的差异无统计学意义；0.98（0.1）对0.80（1.0）（P = 0.11）。SF - 36心理健康、情感角色和MCS量表中的种族差异超过了，而HAQ - DI接近最小临床重要差异阈值。
与白种人相比，患有痛风的非裔美国人的健康相关生活质量明显更差。有必要针对非裔美国人开展进一步研究，以探讨如何最好地改善这些结果。
