Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston.
The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston.
JAMA Netw Open. 2023 Apr 3;6(4):e239501. doi: 10.1001/jamanetworkopen.2023.9501.
Gout disparities among Black individuals in the US have recently been explained by socioclinical factors; however, no information is available among Asian individuals living in Western countries, despite their disproportionately worsening metabolic health.
To determine the prevalence of gout and serum urate concentrations according to race and ethnicity and to explore the association of social determinants of health and clinical factors.
DESIGN, SETTING, AND PARTICIPANTS: This is a population-based, cross-sectional analysis. Data from a nationally representative sample of US adults were obtained from the National Health and Nutrition Examination Survey (NHANES) (2011-2018) in which Asian race data were collected (primary). Data from the UK Biobank (2006-2021) were used for replication of the Asian vs White differences. Data analysis was performed from December 2021 to September 2022.
Race-specific gout prevalence and serum urate levels.
A total of 22 621 participants from NHANES (2011-2018) were included in the analysis (mean [SD] age, 49.8 [17.8] years; 10 948 male participants [48.4%]). In 2017 to 2018, gout affected 12.1 million US individuals, with its crude prevalence increasing from 3.6% (95% CI, 2.8%-4.5%) in 2011 to 2012 to 5.1% (95% CI, 4.2%-5.9%) in 2017 to 2018 (P for trend = .03); this trend was no longer significant after age adjustment (P for trend = .06) or excluding Asian individuals (P for trend = .11). During the same period, age- and sex-adjusted prevalence among Asian Americans doubled from 3.3% (95% CI, 2.1%-4.5%) to 6.6% (95% CI, 4.4%-8.8%) (P for trend = .007) to numerically exceed all other racial and ethnic groups in 2017 to 2018, with age- and sex-adjusted odds ratio (ORs) of 1.61 (95% CI, 1.03-2.51) and a socioclinical factor-adjusted multivariable OR of 2.62 (95% CI, 1.59-4.33) for Asian vs White individuals. The latest age- and sex-adjusted gout prevalence among US individuals aged 65 years and older was 10.0% among White individuals and 14.8% among Asian individuals (including 23.6% of Asian men). Serum urate concentrations also increased between 2011 and 2018 among US Asian individuals (P for trend = .009). The Asian vs White disparity was also present in the UK Biobank.
The findings of this study suggest that the prevalence of gout among Asian individuals numerically surpassed that for all other racial and ethnic groups in 2017 to 2018. This Asian vs White disparity did not appear to be associated with socioclinical factors.
最近，美国黑人群体中痛风的差异可以用社会临床因素来解释；然而，在代谢健康状况日益恶化的情况下，生活在西方国家的亚洲人却没有相关信息。
根据种族和民族确定痛风的患病率和血清尿酸浓度，并探讨社会健康决定因素和临床因素的关联。
设计、地点和参与者：这是一项基于人群的横断面分析。从全国代表性的美国成年人样本中获取数据，这些数据来自国家健康和营养检查调查（NHANES）（2011-2018 年），其中收集了亚洲种族数据（主要）。来自英国生物银行（2006-2021 年）的数据用于复制亚洲与白种人之间的差异。数据分析于 2021 年 12 月至 2022 年 9 月进行。
种族特异性痛风患病率和血清尿酸水平。
共纳入 22621 名来自 NHANES（2011-2018 年）的参与者（平均[标准差]年龄，49.8[17.8]岁；10948 名男性参与者[48.4%]）。2017 年至 2018 年，美国有 1210 万人患有痛风，其粗患病率从 2011 年至 2012 年的 3.6%（95%置信区间，2.8%-4.5%）增加到 2017 年至 2018 年的 5.1%（95%置信区间，4.2%-5.9%）（趋势 P=0.03）；在调整年龄后（趋势 P=0.06）或排除亚洲人后（趋势 P=0.11），这一趋势不再显著。同期，美国亚裔成年人的年龄和性别调整患病率从 2011 年至 2012 年的 3.3%（95%置信区间，2.1%-4.5%）翻了一番，到 2017 年至 2018 年的 6.6%（95%置信区间，4.4%-8.8%）（趋势 P=0.007），2017 年至 2018 年，年龄和性别调整的优势比（ORs）为 1.61（95%置信区间，1.03-2.51），社会临床因素调整的多变量 OR 为 2.62（95%置信区间，1.59-4.33），亚洲与白人相比。在美国，65 岁及以上人群中，最新的年龄和性别调整的痛风患病率在白人中为 10.0%，在亚洲人中为 14.8%（包括 23.6%的亚洲男性）。2011 年至 2018 年，美国亚洲人的血清尿酸浓度也有所增加（趋势 P=0.009）。英国生物银行也存在亚洲人与白人之间的差异。
这项研究的结果表明，2017 年至 2018 年，亚洲人群中痛风的患病率在数字上超过了所有其他种族和民族。这种亚洲与白人之间的差异似乎与社会临床因素无关。
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