Research Spotlight: Racial and Sex Disparities in the Prevalence of Gout Among US Adults

Natalie McCormick, PhD, a postdoctoral research fellow in Clinical Epidemiology Program within the Division of Rheumatology, Allergy and Immunology, was the lead author of a recent paper in JAMA Network Open, Racial and Sex Disparities in Gout Prevalence Among US Adults.

What Question Were You Investigating with this Study?

Are there racial differences in gout prevalence among adults in the US general population, and what might explain these disparities?

Emerging data from smaller cohort studies were suggesting that gout; a common, painful form of inflammatory arthritis that results from the buildup of uric acid crystals in the joints, and hyperuricemia; elevated levels of uric acid in the blood that can be a precursor to gout, may now be more frequent among Black adults in the USA than White adults, especially Black women.

However, there was a lack of national-level, sex-specific data on racial differences in the prevalence of gout in the United States.

What Methods or Techniques Did You Use?

We conducted a cross-sectional analysis using nationally representative decadal survey data from successive cycles of the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016.

A total of 18,693 participants were included in the analysis.

What Did You Find?

Gout has become more prevalent among Black adults in the US general population than White adults, but this racial disparity is explained entirely by differences in social determinants of health and clinical factors, rather than, for example, differences in genes regulating urate handling.

Moreover, there were distinct sex differences in the major explanatory factors, with poverty and body mass index (BMI) being major drivers of the racial differences among women, but not among men. Findings for hyperuricemia were similar.

What Are Your Conclusions?

In this nationally representative race- and sex-specific cross-sectional study of US adults, gout was more prevalent in adults self-reporting Black race during a recent 10-year period compared with their White counterparts:

• 1.8 times greater among Black vs. White women
• 1.3 times greater among Black vs. White men

In contrast, there was no Black-White racial difference during an earlier edition of the NHANES (1988-1994).  The current racial differences may be explained by sex-specific differences in diet and social determinants of health and clinical factors.

What are the Potential Clinical Implications of Your Work?

Culturally sensitive efforts focusing on these socioclinical factors could reduce current gout-related disparities, though changes are likely needed at the population and health system level to reduce social and health inequities (e.g., health impacts of poverty, potential disparities in hypertension care contributing to excess gout risk among Black adults).

Hyon Choi, MD, Director of Clinical Epidemiology at Mass General, was the senior author of the paper.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.