University of Toronto, Toronto, Ontario, Canada.
University of Toronto and Women's College Hospital, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2023 Dec;75(12):2463-2471. doi: 10.1002/acr.25167. Epub 2023 Jun 26.
To assess the proportion of, and factors associated with, older adults with gout receiving a serum urate (SUA) test after starting urate-lowering therapy (ULT).
We performed a population-based retrospective cohort study in Ontario, Canada in patients ages ≥66 years with gout, newly dispensed ULT between 2010 and 2019. We characterized patients with SUA testing within 6 and 12 months after ULT dispensation. Multilevel logistic regression clustered by ULT prescriber evaluated the factors associated with SUA monitoring within 6 months.
We included 44,438 patients with a mean ± SD age of 76.0 ± 7.3 years and 64.4% male. Family physicians prescribed 79.1% of all ULTs. SUA testing was lowest in 2010 (56.4% at 6 months) and rose over time to 71.3% in 2019 (P < 0.0001). Compared with rheumatologists, family physicians (odds ratio [OR] 0.26 [95% confidence interval (95% CI) 0.23-0.29]), internists (OR 0.34 [95% CI 0.29-0.39]), nephrologists (OR 0.37 [95% CI 0.30-0.45]), and other specialties (OR 0.25 [95% CI 0.21-0.29]) were less likely to test SUA, as were male physicians (OR 0.87 [95% CI 0.83-0.91]). Patient factors associated with lower odds of SUA monitoring included rural residence (OR 0.81 [95% CI 0.77-0.86]), lower socioeconomic status (OR 0.91 [95% CI 0.85-0.97]), and patient comorbidities. Chronic kidney disease, hypertension, diabetes mellitus, and coprescription of colchicine/oral corticosteroids (OR 1.31 [95% CI 1.23-1.40]) were correlated with increased SUA testing.
SUA testing is suboptimal among older adults with gout initiating ULT but is improving over time. ULT prescriber, patient, and prescription characteristics were correlated with SUA testing.
评估开始降尿酸治疗（ULT）后，接受血尿酸（SUA）检测的老年痛风患者的比例，以及与接受 SUA 检测相关的因素。
我们在加拿大安大略省进行了一项基于人群的回顾性队列研究，纳入年龄≥66 岁、2010 年至 2019 年期间新开具 ULT 的痛风患者。我们描述了 ULT 开具后 6 个月和 12 个月内进行 SUA 检测的患者特征。采用多水平逻辑回归分析对 ULT 开具者进行聚类，评估了与 6 个月内 SUA 监测相关的因素。
我们共纳入 44438 例患者，平均年龄为 76.0±7.3 岁，64.4%为男性。家庭医生开具了所有 ULT 的 79.1%。SUA 检测率在 2010 年最低（6 个月时为 56.4%），此后随着时间的推移逐渐上升，到 2019 年达到 71.3%（P<0.0001）。与风湿病专家相比，家庭医生（比值比[OR]0.26[95%置信区间（95%CI）0.23-0.29]）、内科医生（OR 0.34[95%CI 0.29-0.39]）、肾病专家（OR 0.37[95%CI 0.30-0.45]）和其他专科医生（OR 0.25[95%CI 0.21-0.29]）进行 SUA 检测的可能性较低，男性医生（OR 0.87[95%CI 0.83-0.91]）也较少进行 SUA 检测。SUA 监测可能性较低的患者因素包括农村居住（OR 0.81[95%CI 0.77-0.86]）、较低的社会经济地位（OR 0.91[95%CI 0.85-0.97]）和患者合并症。慢性肾脏病、高血压、糖尿病和同时开具秋水仙碱/口服皮质类固醇（OR 1.31[95%CI 1.23-1.40]）与 SUA 检测增加相关。
开始 ULT 治疗的老年痛风患者的 SUA 检测不理想，但随着时间的推移正在改善。ULT 开具者、患者和处方特征与 SUA 检测相关。
