| 1. |
- Dehlin, Mats, 1968, et al.
(författare)
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Incidence and prevalence of gout in Western Sweden
- 2016
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of the present study was to describe prevalence and trends in the incidence of gout and patterns of urate-lowering treatment (ULT) in the Western Swedish Health Care Region (WSHCR) from 2002 to 2012. Methods: We used regional and national healthcare registers to estimate the prevalence and incidence of gout in 2012, and trends in incidence for each calendar year from 2005 to 2012. We also investigated the pattern of ULT for gout using the Swedish Prescribed Drug Register. Results: In 2012, in the population aged 20 years and above, the prevalence of gout was 1.8 % (95 % confidence interval (CI) 1.77 to 1.82) and the incidence was 190 cases (95 % CI 180 to 200) per 100,000 person-years. Applying more strict definitions for a gout case rendered a prevalence of 1.36 % (95 % CI 1.34 to 1.38) and 0.5 (95 % CI 0.49 to 0.51) per 100,000 person-years, respectively. The incidence of gout increased steadily and significantly from 2005 to 2012, with an almost 50 % increase in the total population. There was no significant difference in the prevalence of gout in rural compared to urban areas. ULT was dispensed to only 42 % of patients with gout in 2012 who had ever been diagnosed with gout during the preceding 10-year period. Conclusions: Gout is the most common arthritic disease in WSHCR, Sweden, and has increased substantially over the last decade, with only a minority of prevalent cases in 2012 receiving ULT.
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| 2. |
- Drivelegka, Panagiota, et al.
(författare)
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Association between serum level of urate and subclinical atherosclerosis: results from the SCAPIS Pilot
- 2020
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Background Hyperuricemia is closely associated with cardiovascular disease (CVD). However, it has not been definitively established whether this association is independent of traditional cardiovascular risk factors (CVRFs) and whether it is gender-dependent. The aim of this study was to investigate in a population-based cohort (age range, 50-64 years) stratified by sex the association between the serum urate (SU) concentration and subclinical atherosclerosis, as reflected in the coronary artery calcification (CAC) score, common carotid intima-media thickness (CIMT), and carotid plaque score. Methods The study involved participants in the Swedish CArdioPulmonary bioImage Study (SCAPIS) Pilot cohort (N = 1040; 48.8% males). This pilot cohort is part of the large population-based SCAPIS with 30,000 participants in the age range of 50-64 years, aimed at improving risk prediction for CVD. Subjects with a self-reported previous history of CVD (N = 68) or gout (N = 3) were excluded. The CAC score was assessed with the Agatston method using computed tomography. CIMT and carotid plaques were quantified by ultrasound. The associations between the SU quartiles and different levels of CAC, CIMT, and carotid plaques were assessed by multivariable logistic regression. Results Age, BMI, education level, smoking, physical activity, hs-CRP, hypertension, and dyslipidemia showed no differences between males and females, while CAC (score > 0) and diabetes were both twice as common in men than in women (58% vs 26% and 8% vs 4%, respectively). Higher SU quartiles were in both sexes associated with BMI, hs-CRP, and the prevalence of hypertension, and in women, they were also associated with the prevalence of dyslipidemia. The three upper quartiles of SU (>308 mu mol/L) were linked to higher CAC scores in men, when adjusting for CVRFs, but not in women. CIMT and carotid plaques showed no correlation to SU in either sex. Conclusions Higher levels of SU are associated with the presence of CAC in men but not in women, whereas SU is not associated with CIMT or carotid plaques in either men or women. This implies that the biological effects of SU differ in men and women or that SU has varying effects on different vascular beds or during the different stages of the atherosclerotic process.
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| 3. |
- Drivelegka, Panagiota, et al.
(författare)
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Comorbidity in gout at the time of first diagnosis: sex differences that may have implications for dosing of urate lowering therapy
- 2018
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 20:108
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study is to examine the occurrence of comorbidities at the time of first diagnosis of gout compared with matched population controls, overall and by sex, as well as to examine the crude and age-standardized prevalence of these comorbidities in men and women with gout at first diagnosis. Methods: A population-based study used data from Swedish national and regional registers, including 14,113 gout patients aged >= 20 years, with a first recorded diagnosis of gout between 1 January 2006 and 31 December 2012, and 65,782 population controls, matched by age, sex and county. Prevalence ratios (95% confidence intervals) comparing gout cases and controls were calculated, overall and by sex. Crude and age-standardized prevalence (95% confidence interval) of all comorbidities in gout patients were calculated, to show differences between sexes, taking also the higher age at diagnosis in women into account. Results: All examined comorbidities were 1.2-2.5-fold more common in gout patients at diagnosis than in population controls in both sexes. Women with gout were on average 6 years older than men at first gout diagnosis and most comorbidities, including obesity and diuretic use, were or tended to be more frequent in women than in men. When standardizing for age, women had a higher prevalence of thromboembolism (6.6% vs 5.2%) and chronic obstructive pulmonary disease (3.1% vs 2.4%). Men, on the other hand, had a higher prevalence of coronary heart disease (9.4% vs 6.4%), atrial fibrillation (9.0% vs 6.0%), congestive heart failure (7.7% vs 6.6%) and stroke (4.1% vs 3.3%). Conclusions: The occurrence of most comorbidities was significantly increased at first diagnosis of gout in both sexes. Women were older at diagnosis and had higher occurrence of most comorbidities, including obesity and diuretic use, factors that increase serum urate, and this needs to be taken into account when starting and optimizing urate lowering therapy. These sex differences were attenuated when standardizing for age and the occurrence of cardiovascular diseases was actually higher in men. BOTT RD, 1988, JOURNAL OF CLINICAL EPIDEMIOLOGY, V41, P237
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| 4. |
- Drivelegka, Panagiota, et al.
(författare)
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Incident gout and risk of first-time acute coronary syndrome: a prospective, population-based, cohort study in Sweden
- 2023
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 75:6, s. 1292-1299
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the risk of first-time acute coronary syndrome (ACS) in a large cohort of primary and secondary care patients with incident gout, compared to the general population. Methods: Using register data for the period 2007 ̶ 2017, we conducted a prospective, population-based cohort with 20,146 patients with incident gout (mean age, 65.6 years; 67.4% males) and 83,517 matched population controls, without prior history of coronary heart disease. We calculated incidence rates (IR) and hazard ratios (HR) adjusted for baseline comorbidities and dispensed prescriptions. In a sensitivity analysis, we included gout cases and controls with no previously diagnosed comorbidity (6,075 cases and 44,091 controls). Results: The IR of first-time ACS was significantly increased in the gout cohort, compared to controls (9.1 vs 6.3/1,000 person-years). Unadjusted cox regression showed that gout patients had higher risk of first-time ACS compared to controls (HR, 1.44; 95%CI, 1.33-1.56), with higher HR in women (HR, 1.64; 95%CI, 1.41 ̶ 1.90) than in men (HR, 1.36; 95%CI, 1.24 ̶ 1.50). In multivariable analysis the risk diminished but remained significant (HR, 1.15; 95%CI, 1.06-1.25). The risk was similar in the sensitivity analysis (HR, 1.20; 95%CI, 1.01-1.44), and still higher in women (HR, 1.34; 95%CI, 0.86-2.08), than in men (HR, 1.18; 95%CI, 0.97-1.44). Conclusion: Patients with incident gout have a 44% increased risk of first-time ACS, higher in women than in men. This risk is largely explained by the underlying comorbidities, but there is still a modestly increased risk that may be due to gout-related factors.
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| 5. |
- Drivelegka, Panagiota
(författare)
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The population burden of gout and urate in Western Sweden : Prevalence, incidence, comorbidities, and association with cardiovascular disease
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Gout is the most common type of inflammatory arthritis and is associated with several comorbidities and an increased risk of cardiovascular disease (CVD). However, data on the epidemiology and comorbidity patterns of gout in Sweden are scarce, and whether its association with CVD is causal or not, is not clear. Objectives: This thesis aimed to study: I. The incidence and prevalence of gout, and use of urate lowering treatment (ULT) in Western Sweden in 2012; II. The comorbidity pattern of gout at the time of first diagnosis; III. The association between urate levels and markers of subclinical atherosclerosis; IV. The risk of first-time acute coronary syndrome (ACS) in patients with incident gout, compared to the general population. Methods: Part I. By using data from the population-based register VEGA, we identified all patients with ≥1 ICD-coded diagnosis of gout at both primary and specialized health care in Western Sweden. Their dispensed prescriptions were identified through linkage with Prescribed Drug Register. Part II. Cases with first ICD-coded gout diagnosis in the period 2006-2012 were matched to population controls on age, sex, and county at first gout diagnosis. We estimated crude, and age-standardized prevalence and prevalence ratios. Part III. Participants of the pilot Swedish CArdioPulmonary bioImage Study (SCAPIS) underwent radiographic investigations for estimation of Coronary Artery Calcification score (CAC), carotid intima-media thickness (CIMT) and carotid plaque score. Their association with urate levels was assessed with logistic regression analysis. Part IV. Cohorts of patients with incident gout and population controls followed prospectively. Incidence rates (IRs), incidence rate ratios (IRRs), and hazard ratios (HRs) were used for risk estimations. Results: Part I. The prevalence of gout in adults aged ≥ 20 years in 2012 was 1.8% and the incidence was 190 cases per 100,000 person-years. The incidence increased by 50% from 2005 to 2012. Only 42% of gout patients received ULT in 2012. Part II. At the time of first diagnosis, 77% of gout patients had at least one comorbidity, as compared to 56% of the controls. Women with gout were six years older and had higher occurrence of most comorbidities, compared to men. Part III. Serum urate levels >308 µmol/L were associated with the presence of CAC in men (p-value <0.05), but not in women, whereas urate levels were not associated with CIMT or carotid plaques in either men or women. Part IV. Patients with incident gout were at increased risk of first-time ACS, compared to the general population (HR, 1.44; 95%CI, 1.33-1.56). After adjustments for traditional cardiovascular risk factors, this risk was attenuated, but remained significant (HR, 1.15; 95%CI, 1.06-1.25). Conclusions: Gout has an increasing incidence in Western Sweden, but only a minority of gout patients received ULT. The comorbidity burden at the time of first gout diagnosis is high, particularly in women. Urate may be associated with coronary calcification in men. Gout patients are at increased risk of first-time ACS, which is mainly depending on the underlying comorbidities and, to a lesser extent, on gout itself. Our results imply the importance of improvements in the management of gout and its comorbidities in the Swedish health care system, for increased longevity and better quality of life for these patients.
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| 6. |
- Landgren, Anton J., 1989, et al.
(författare)
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Incidence of and risk factors for nephrolithiasis in patients with gout and the general population, a cohort study
- 2017
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6354 .- 1478-6362. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nephrolithiasis (NL) is known to be associated with gout, although there are few comparative studies on risk and risk factors for NL in gout compared to population cohorts. In this cohort study we investigated: (1) overall incidence of NL in gout (cases) and general population controls; (2) risk and risk factors (common comorbidities and medications) for first-time NL in cases and controls separately. Methods: Cases (n = 29,968) and age-matched and sex-matched controls (n = 138,678) were identified from the regional healthcare database in western Sweden (VEGA). The analyzed risk factors (comorbidities and current medication use) for first-time NL, and socioeconomic factors were retrieved from VEGA and other national Swedish registers. For cases, follow up began on 1 January 2006 or on the first diagnosis of gout if this occurred later, and for controls on their index patient's first diagnosis of gout. Follow up ended on death, emigration or 31 December 2012. Incidence rates (IR) per 1000 person-years and hazard ratios (HR) were calculated. The incidence calculations were performed for cases (regardless of prior NL) and their controls. HRs with first occurrence of NL as outcome were calculated only in those without previous NL. Results: In cases there were 678 NL events (IR: 6.16 events per 1000 person-years (95% CI: 5.70-6.64) and in controls 2125 NL events (IR 3.85 events per 1000 person-years (95% CI: 3.69-4.02), resulting in an age-sex-adjusted incidence rate ratio of 1.60 (95% CI: 1.47-1.74). Point estimates for predictive factors were similar in cases and controls, except for a significant interaction for losartan which increased the risk of NL only in controls (HR = 1.49 (95% CI: 1.03-2.14). Loop diuretics significantly decreased the risk of NL by 30-34% in both cases and controls. Further significant predictors of NL in gout cases were male sex, diabetes and obesity and in controls male sex and kidney disease. Conclusions: The risk (age and sex adjusted) of NL was increased by 60% in cases compared to controls. None of the commonly used medications increased the risk of NL in gout patients.
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| 7. |
- Sigurdardottir, Valgerdur, et al.
(författare)
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Work disability in gout: a population-based case-control study
- 2018
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 77:3, s. 399-404
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Tidskriftsartikel (refereegranskat)abstract
- To examine the extent and cost of work disability among patients with gout compared with matched population controls and to analyse predictors of work disability.A regional cohort study using data from Swedish national and regional registries from January 2000 through December 2012, including 4571 patients with gout of working age, with a first recorded diagnosis of gout in the years 2003-2009 and 22482 population controls, matched by age, sex and place of residence. Differences in baseline characteristics (educational level, income, previous employment and comorbidities) and the number of work-loss days (absenteeism) due to sick leave and disability pension for 3 years after identification were calculated. Predictors for new-onset work absenteeism (>90days/year) in a subset were determined by conditional logistic regression.Patients with gout (median age 53years) had significantly more comorbidities, lower income and lower level of education than matched controls. The average work absentee rate during the 3-year follow-up period was higher among patients with gout than controls, 22% and 14%, respectively (P<0.0001). New-onset absenteeism was in multivariate analyses significantly predicted by gout (OR 1.47; 95%CI 1.23 to 1.75). Other variables independently related to new-onset absenteeism were education ≤12years, previous unemployment and history of sick leave, in addition to several comorbidities (renal disease, cardiovascular disease, alcohol abuse and obesity). Gout is associated with substantially higher work absenteeism and costs for society due to productivity loss, after adjusting for associated comorbidities and socioeconomic differences. Whether more intensive treatment of gout is cost-effective needs to be addressed in future studies.
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