Gender Blindness Necessitates Special Clinical Consideration for Women With Gout

Women with gout tend to be of more advanced age and have comorbid diagnoses of heart failure, obesity, diabetes mellitus, chronic kidney disease, and hyperlipidemia.

Given the differing comorbidities between men and women with gout, special clinical consideration should be given to women to address gender blindness and ensure the best possible care, according to results of an observational, multicenter, cross-sectional study published in Rheumatic & Musculoskeletal Diseases Open.

Gender blindness, defined as differences in the treatment of individuals based on the social conception of men and women, is present in medicine and may specifically exist among patients with gout. Data on women with gout are under-published and current guidelines do not offer specific recommendations for women with gout, despite disease presentation differing between the sexes. To address this gap, investigators compared differences in the prevalence and presentation of comorbidities among men vs women hospitalized with gout.

Data were taken from the minimum basic data set, containing details on all patient hospitalizations in both private and public hospitals in Spain from January 2005 through December 2015. Patients aged at least 18 years with a primary or secondary diagnosis of gout were included in the study. Multivariable logistic regression was used to evaluate the association between various comorbidities and sex.

A total of 192,037 hospital admissions were assessed, with gout as the primary diagnosis in 5.5% (10,512) of patients and the secondary diagnosis in 94.5% (181,518) of patients. Far more men (82.6%) than women (17.4%) were hospitalized with gout. Women with gout were of more advanced age than men (mean age, 73.9±13.7 years vs 64.0±14.4 years; P <.001, respectively).

Our results imply women with gout should be approached with special consideration in clinical practice to address gender blindness and guarantee the best care from healthcare professionals.

Comorbidities that were found to be more common in women vs men included dementia (2.1% vs 1.2%), heart failure (31.8% vs 16.6%), diabetes mellitus (36.2% vs 26.0%), chronic kidney disease (33.8% vs 25.1%), dyslipidemia (31.8% vs 30.7%), obesity (16.3% vs 10.8%), urinary tract infection (12.0% vs 5.4%), and concurrent rheumatic disease (2.6% vs 1.4%).

Comorbidities that were found to be more common in men vs women included coronary heart disease (21.8% vs 16.9%), liver disease (2.2% vs 1.3%), obstructive pulmonary disease (8.9% vs 2.3%), pneumonia (4.5% vs 3.8%), and peripheral vascular disease (3.8% vs 1.2%).

According to positive coefficient values, logistic regression revealed more advanced age (+0.71), heart failure (+0.24), diabetes mellitus (+0.19), obesity (+0.21), and urinary tract infection (+0.20) were strongly associated with female sex.

According to negative coefficient values, logistic regression revealed male sex was associated with peripheral vascular disease (-0.20), coronary heart disease (-0.23), and obstructive pulmonary disease (-0.39).

No between-sex differences were found in prevalence of sepsis (P =.34), cerebrovascular disease (P =.74), venous thromboembolism (P =.97), or arrhythmia (P =.53). Differences in prevalence of dementia were no longer present following stratification by age group.

Study limitations include its cross-sectional design and the exclusion of certain notable comorbidities due to their extremely low prevalence.

“This analysis of the Spanish hospital database demonstrates that women with gout are almost 10 years older than men and suffer from heart failure, obesity, diabetes mellitus, dyslipidemia and chronic kidney disease, in some cases with differences exceeding 10 percentage points, compared with men,” the study authors stated.

“Our results imply women with gout should be approached with special consideration in clinical practice to address gender blindness and guarantee the best care from healthcare professionals,” they concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Rodríguez-Sosa E, De Miguel E, Borrás F, Andrés M. Filling gaps in female gout: a cross-sectional study of comorbidities in 192 037 hospitalized patients. RMD Open. Published online June 9, 2023. doi:10.1136/rmdopen-2023-003191