The Gout Index
& Need For Gout Awareness
Gout is a chronic disease that affects more than nine million people in the US and causes intense painful attacks. It is a misunderstood disease, frequently undiagnosed or misdiagnosed. The social stigma regarding gout can also lead to patients’ reluctance to report the condition and seek treatment.
Gout is caused by increased levels of uric acid, a naturally occurring waste product, in the body. It is a form of arthritis that can result in sudden, intense pain and swollen joints. Hereditary factors may lead to incidences of gout, although certain foods and medications can also trigger episodes. Patients with gout are at heightened risk for several chronic conditions, while some chronic conditions like kidney disease can increase the risk of gout. Left untreated, gout attacks can become more frequent, prolonged and debilitating.
Persisting Stigmas
A lack of education about gout, even among health care providers, has allowed social stigmas to persist. This has prevented open discussion about gout and its related genetic factors and disparities in diagnosis and treatment.
While effective treatments exist, greater awareness is needed to ensure patients receive appropriate and timely treatment. As with other chronic conditions, the severity and consequences of gout are especially troubling in ethnic and racial minority communities.
The Gout Index
The multitude of patients with gout, its intense symptoms and the harmful social stigma all contribute to a need for enhanced awareness. This need prompted the National Minority Quality Forum to launch a project in 2021 aimed at better understanding gout and its impact on patients, specifically Medicare beneficiaries.
The project began with an analysis of data obtained from the Centers for Medicare and Medicaid Services. It focused on the geographic, socioeconomic, racial and ethnic prevalence of gout cases, as well as health care utilization and cost information.
To generate a foundation of information about gout, NMQF created the Gout Index. The Gout Index is comprised of aggregated chronic gout claims data from the 2016 Master Beneficiary Summary Files (including Chronic Condition and Cost and Utilization Segments), Medicare Outpatient, and Carrier Files. Details and data found in the Gout Index were also reviewed by a group of Advisory committee members.
Findings
The data demonstrated a high prevalence of gout in the southeast United States. The committee considered that these states typically lag in public health investment; have a cultural affinity for types of food that can contribute to gout flare-ups; and have more limited access to higher-priced, less processed food.
“These are populations that have increased risk for cardiometabolic diseases and often don’t get the best care,” one committee member said. “We know that, in so many of the higher risk communities, the store attached to the gas station is the only place to food shop.”
The data also revealed an overlap between obesity prevalence maps and the Gout Index, suggesting that policymakers need to be made aware of this connection.
GOUT AFFECTS MILLIONS OF INDIVIDUALS EACH YEAR YET MANY GO UNDIAGNOSED
To learn more about the prevelance of gout in your area, check out NMQF's Gout Index.
Disparities In Gout Care
Advisory committee members detailed various types of disparities that gout patients face, from a greater degree of misdiagnoses to a lack of access to resources that can reduce the risk of a flare.
Some providers are mismanaging medication for gout patients, making it difficult for patients to control the disease. An expert in health education noted that the Gout Index showed that areas of lower gout prevalence typically have worse patient outcomes, indicating that there were information voids in these predominantly rural and underprivileged areas.
There was considerable focus on the need to address broader health inequities in our society that have a severe effect on gout patients.
Poor financial circumstances can impair a patient’s ability to control their gout. They might not have the money or accessible transportation to travel to get groceries, let alone go to a rheumatology appointment.
