Gout and Hospital Admission for Ambulatory Care-Sensitive Conditions: Risks and Trajectories
- PMID: 35428711
- PMCID: PMC10522403
- DOI: 10.3899/jrheum.220038
Gout and Hospital Admission for Ambulatory Care-Sensitive Conditions: Risks and Trajectories
Abstract
Objective: To investigate the risks and trajectories of hospital admission for ambulatory care-sensitive conditions (ACSCs) in gout.
Methods: Among individuals aged 35 years to 85 years residing in Skåne, Sweden, in 2005, those with no doctor-diagnosed gout during 1998 to 2005 (n = 576,659) were followed from January 1, 2006, until a hospital admission for an ACSC, death, relocation outside Skåne, or December 31, 2016. Treating a new gout diagnosis (International Classification of Diseases, 10th revision, code M10) as a time-varying exposure, we used Cox proportional and additive hazard models to estimate the effects of gout on hospital admissions for ACSCs. We investigated the trajectory of hospital admissions for ACSCs from 3 years before to 3 years after gout diagnosis using generalized estimating equations and group-based trajectory modeling in an age-and sex-matched cohort study.
Results: Gout was associated with a 41% increased rate of hospital admission for ACSCs (hazard ratio 1.41, 95% CI 1.35-1.47), corresponding to 121 (95% CI 104-138) more hospital admissions for ACSCs per 10,000 person-years compared with those without gout. Our trajectory analysis showed that higher rates of hospital admission for ACSCs among persons with gout were observed from 3 years before to 3 years after diagnosis, with the highest prevalence rate ratio (2.22, 95% CI 1.92-2.53) at the 3-month period after diagnosis. We identified 3 classes with distinct trajectories of hospital admissions for ACSCs among patients with gout: almost none (88.5%), low-rising (9.7%), and moderate-sharply rising (1.8%). The Charlson Comorbidity Index was the most important predictor of trajectory class membership.
Conclusion: Increased risk of hospital admissions for ACSCs in gout highlights the need for better management of the disease through outpatient care, especially among foreign-born, older patients with comorbidities.
Keywords: ambulatory care; gout; heterogeneity; hospitalization; longitudinal study; population registers.
Copyright © 2022 by the Journal of Rheumatology.
Conflict of interest statement
ME has received honorarium for serving on a 1-day advisory board (November 26, 2018) for Pfizer (tanezumab). All other authors declare no conflict of interest relevant to this article.
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