Department of Rheumatology, The Queen Elizabeth Hospital, Woodville South, Australia.
Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
Arthritis Res Ther. 2018 Jul 11;20(1):143. doi: 10.1186/s13075-018-1633-9.
Gout has an increasing global prevalence. Underutilization of urate-lowering therapy (ULT) is thought to be common, via both suboptimal dosing and poor medication adherence. The aims of this study were to determine the prevalence of self-reported gout and the key predictors of ULT use in those with gout in a representative population survey in South Australia.
Data were obtained from the Spring 2015 South Australian Health Omnibus Survey, a multilevel, systematic, survey in a representative population sample involving face-to-face interviews (n = 3005). This study analyzed responses from respondents aged ≥ 25 years (n = 2531) about self-reported gout, ULT use, sociodemographic factors, lifestyle factors, and comorbidities, using survey weighting. Univariate and subsequent adjusted logistic regression analyses on self-reported gout were performed. ULT use was divided into three categories (never use, prior use, and current use) and these data were analyzed using a multinomial logistic regression model.
Self-reported gout prevalence was 6.8% (95% CI 5.8, 7.9). The mean age of respondents with gout was 64 years (standard deviation 16) and 82% were male. As expected, older age, male gender, lower socioeconomic status (SES), and higher body mass index (BMI) were associated with gout, as were high alcohol consumption, current smoking, other forms of arthritis, and hypertension or hypercholesterolemia medication, after adjustment for sociodemographic variables. Two thirds of respondents with gout reported ULT use (36% current; 29% previous) with only 55% continuing treatment. Predictors of ULT use included male gender, low SES, and concomitant cholesterol-lowering therapy. Respondents with gout with a higher BMI were more likely to remain on ULT.
Despite gout being a common, potentially disabling joint disease, only 55% of respondents with gout in this study adhered to ULT. Identification of key predictors of ULT use will provide guidance on prescribing strategy in clinical practice and on the quality of gout care in the community.
痛风的全球患病率呈上升趋势。人们认为，降尿酸治疗（ULT）的利用率较低，这既与剂量不足有关，也与药物依从性差有关。本研究的目的是在南澳大利亚的一项代表性人群调查中，确定自我报告的痛风患病率以及痛风患者使用 ULT 的主要预测因素。
数据来自 2015 年春季南澳大利亚健康普查，这是一项在代表性人群样本中进行的多层次、系统的调查，涉及面对面访谈（n=3005）。本研究分析了年龄≥25 岁的受访者（n=2531）关于自我报告的痛风、ULT 使用、社会人口因素、生活方式因素和合并症的回答，使用调查权重。对自我报告的痛风进行单变量和随后的调整后逻辑回归分析。将 ULT 使用分为三类（从未使用、以前使用和当前使用），并使用多项逻辑回归模型对这些数据进行分析。
自我报告的痛风患病率为 6.8%（95%CI 5.8，7.9）。有痛风的受访者的平均年龄为 64 岁（标准差 16），82%为男性。正如预期的那样，年龄较大、男性、较低的社会经济地位（SES）和较高的体重指数（BMI）与痛风有关，在调整社会人口变量后，高酒精消耗、当前吸烟、其他形式的关节炎、高血压或高胆固醇血症药物也是如此。三分之二的痛风患者报告使用 ULT（36%当前；29%以前），只有 55%继续治疗。ULT 使用的预测因素包括男性、低 SES 和同时进行的降胆固醇治疗。BMI 较高的痛风患者更有可能继续使用 ULT。
尽管痛风是一种常见的、潜在致残性关节疾病，但在这项研究中，只有 55%的痛风患者坚持使用 ULT。确定 ULT 使用的关键预测因素将为临床实践中的处方策略以及社区中痛风护理的质量提供指导。
