Social Determinants of Health and Risk of Mortality in Adults with Gout or Hyperuricemia: Insights from the 1999-2018 NHANES.

BACKGROUND

Hyperuricemia and gout are common metabolic disorders that show substantial disparities in prevalence and management across different socioeconomic status.

AIMS: To investigate the association between social determinants of health (SDOH) and mortality risk in adults with hyperuricemia and/or gout, to assess whether the interaction between SDOH and gout/hyperuricemia status influences mortality risk.

STUDY

DESIGN

A retrospective cohort study.

METHODS

We analyzed 6,560 United States (US) adults (mean age 58 years, 60.02% men) with hyperuricemia and/or gout from the 1999-2018 National Health and Nutrition Examination Survey. The primary study outcomes were all-cause and cardiovascular mortality. A control group of 6,560 adults without hyperuricemia or gout was measured using propensity-score matching based on age, sex, and race. SDOH was measured using a composite score (range 0-8) created from eight socioeconomic indicators: education, employment, food security, family income-to-poverty ratio, marital status, health insurance coverage, insurance type, and home ownership.

RESULTS

Over a median follow-up of 101 months, 1,335 (14.76%) deaths occurred among participants with hyperuricemia and/or gout, including 496 (5.33%) cardiovascular deaths. Relative to adults with hyperuricemia and/or gout who had an SDOH score of 7-8, the hazard ratios (95% confidence intervals) for those with SDOH scores of 5-6, 3-4, and ≤ 2 were 1.48 (1.21-1.81), 1.85 (1.49-2.28), and 2.38 (1.82-3.11), respectively, for all-cause mortality, and 1.62 (1.16-2.25), 1.65 (1.18-2.31), and 2.10 (1.24-3.54), respectively, for cardiovascular mortality. Restricted cubic spline analyses demonstrated an inverse relationship between SDOH and both mortality outcomes. Subgroup analysis indicated that the association between SDOH and mortality risk was stronger among participants younger than 60 years. Interaction analyses showed that hyperuricemia/gout status did not significantly modify the association between SDOH and mortality.

CONCLUSION

Cumulative social disadvantage, indicated by a lower SDOH score, independently predicted higher mortality risk in US adults with hyperuricemia and/or gout, with the most pronounced effects observed in individuals under 60 years. Notably, the unfavorable cardiovascular effects associated with SDOH appeared more evident in adults without hyperuricemia or gout than in those with these conditions.