Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska.
University of Nebraska Medical Center, Omaha.
Arthritis Care Res (Hoboken). 2023 Apr;75(4):808-816. doi: 10.1002/acr.24881. Epub 2022 Nov 11.
To compare all-cause and cause-specific mortality risk between patients with gout and patients without gout in the Veteran's Health Administration (VHA).
We performed a matched cohort study, identifying patients with gout in the VHA from January 1999 to September 2015 based on the presence of ≥2 International Classification of Diseases, Ninth Revision codes for gout (274.X). Gout patients were matched up to 1:10 on birth year, sex, and year of VHA enrollment with patients without gout and followed until death or end of study (December 2017). Cause of death was obtained from the National Death Index. Associations of gout with all-cause and cause-specific mortality were examined using multivariable Cox regression.
Gout (n = 559,243) and matched non-gout controls (n = 5,428,760) had a mean age of 67 years and were 99% male. There were 246,291 deaths over 4,250,371 patient-years in gout patients and 2,000,000 deaths over 40,441,353 patient-years of follow-up in controls. After matching, gout patients had an increased risk of death (hazard ratio [HR] 1.09 [95% confidence interval (95% CI) 1.08-1.09]), which was no longer present after adjusting for comorbidities (HR 0.98 [95% CI 0.97-0.98]). The strongest association of gout with cause-specific mortality was observed with genitourinary conditions (HR 1.50 [95% CI 1.47-1.54]). Gout patients were at lower risk of death related to neurologic (e.g., Alzheimer's disease and Parkinson's disease) (HR 0.63 [95% CI 0.62-0.65]) and mental health (HR 0.66 [95% CI 0.65-0.68]) conditions.
A higher risk of death among gout patients in the VHA was related to comorbidity burden. While deaths attributable to neurologic and mental health conditions were less frequent among gout patients, genitourinary conditions were the most overrepresented causes of death.
比较退伍军人事务部（VHA）中痛风患者和非痛风患者的全因和特定病因死亡率。
我们进行了一项匹配队列研究，根据痛风的≥2 个国际疾病分类，第九修订版代码（274.X），从 1999 年 1 月至 2015 年 9 月在 VHA 中确定痛风患者。痛风患者与非痛风患者按出生年份、性别和 VHA 入组年份进行 1:10 匹配，并随访至死亡或研究结束（2017 年 12 月）。死因从国家死亡指数获得。使用多变量 Cox 回归分析痛风与全因和特定病因死亡率的关系。
痛风（n=559243）和匹配的非痛风对照组（n=5428760）的平均年龄为 67 岁，99%为男性。痛风患者有 246291 例死亡，随访时间为 4250371 患者年；对照组有 2000000 例死亡，随访时间为 40441353 患者年。匹配后，痛风患者的死亡风险增加（风险比[HR]1.09[95%置信区间（95%CI）1.08-1.09]），但在调整合并症后风险不再增加（HR 0.98[95%CI 0.97-0.98]）。痛风与特定病因死亡率相关性最强的是泌尿生殖系统疾病（HR 1.50[95%CI 1.47-1.54]）。痛风患者死于神经（如阿尔茨海默病和帕金森病）（HR 0.63[95%CI 0.62-0.65]）和心理健康（HR 0.66[95%CI 0.65-0.68]）疾病的风险较低。
VHA 中痛风患者的死亡风险较高与合并症负担有关。虽然痛风患者死于神经和心理健康疾病的频率较低，但泌尿生殖系统疾病是最常见的死亡原因。
