Dehlin Mats, Sandström Tatiana Zverkova, Jacobsson Lennart Th
Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Front Med (Lausanne). 2022 Feb 24;9:802856. doi: 10.3389/fmed.2022.802856. eCollection 2022.
Excess mortality in gout has been attributed to cardiovascular diseases (CVD). Considering the decline in CVD mortality in the general population, we wanted to evaluate overall mortality in gout and cause-specific contributions to mortality beyond CVD and temporal trends.
All incident cases of gout between 2006 and 2015 in western Sweden and 5 population controls per case matched for age, sex, and county were identified. Comorbidities were identified for 5 years preceding the index date. Follow-up ended at death, migration, or end of study on December 2017. Effect of gout on death risk was calculated using COX regression on the whole population and stratified by sex, adjusted for demographics, and comorbidities. Death incidence rates were compared between the two time periods, 2006-2010 and 2011-2015.
We identified 22,055 cases of incident gout and 98,946 controls, median age (Q1, Q3) 69-68 (57, 79/56, 78) years and 67.6-66.5% males. Except for dementia, all comorbidities were significantly more common at baseline among gout cases. Overall, the risk for death in incident gout was neither increased overall nor in men, but women had a 10% elevated risk. In adjusted models for cause-specific mortality, death from CVD, renal disease, and digestive system diseases were significantly increased in the total gout population while death from dementia, cancer, and lung diseases were significantly decreased. There were no significant differences in overall incident death rate ratios between cases and controls in the two time periods examined.
An increased risk for CVD, renal disease, and diseases of the digestive system in patients with gout highlights the importance of addressing CVD risk factors in gout management. Gout was associated with reduced mortality from dementia, which may have implications on urate lowering therapy and possible effects on dementia risk.
痛风患者的超额死亡率一直被归因于心血管疾病（CVD）。鉴于普通人群中CVD死亡率呈下降趋势，我们希望评估痛风患者的总体死亡率，以及除CVD之外的特定病因对死亡率的贡献及其时间趋势。
确定了2006年至2015年瑞典西部所有痛风新发病例，并为每个病例匹配5名年龄、性别和所在县相匹配的人群对照。在索引日期前5年确定合并症。随访至死亡、迁移或2017年12月研究结束。使用COX回归分析痛风对全人群死亡风险的影响，并按性别分层，对人口统计学和合并症进行校正。比较2006 - 2010年和2011 - 2015年这两个时间段的死亡发病率。
我们确定了22,055例痛风新发病例和98,946名对照，年龄中位数（第一四分位数，第三四分位数）分别为69 - 68（57, 79/56, 78）岁和67.6 - 66.5%为男性。除痴呆症外，所有合并症在痛风病例的基线时都明显更常见。总体而言，痛风新发病例的死亡风险在总体上以及男性中均未增加，但女性的死亡风险升高了10%。在特定病因死亡率的校正模型中，痛风患者总体人群中CVD、肾脏疾病和消化系统疾病导致的死亡显著增加，而痴呆症、癌症和肺部疾病导致的死亡显著减少。在所检查的两个时间段内，病例组和对照组的总体新发死亡率比值没有显著差异。
痛风患者患CVD、肾脏疾病和消化系统疾病的风险增加，凸显了在痛风管理中解决CVD危险因素的重要性。痛风与痴呆症死亡率降低有关，这可能对降尿酸治疗以及对痴呆症风险的可能影响具有启示意义。
