The effect of gout on health-related quality of life, work productivity, resource use and clinical outcomes among patients with hypertension

Abstract

Although gout has been found to be associated with health-related quality of life (HRQoL), few studies have examined the burden of gout in the presence of concomitant cardiometabolic conditions. The present study evaluated the effect of gout on HRQoL and work productivity among patients with hypertension. Data from the 2010 National Health and Wellness Survey were obtained for respondents ≥18 years of age who had self-reported, physician-diagnosed hypertension or blood pressure levels ≥140/90 mmHg (≥130/80 mmHg for those with physician-diagnosed diabetes or chronic kidney disease). Bivariate analysis was used to evaluate differences between patients with and without self-reported comorbid gout. Generalized linear models were used to evaluate differences in productivity (using the Work Productivity and Activity Impairment scale) and HRQoL (using the physical component summary [PCS], mental component summary and health utilities from the SF-12v2 health survey). As uric acid levels may influence other organ systems, core modeling did not include comorbidities other than osteoarthritis and depression as covariates. Sensitivity analyses were controlled for the Charlson comorbidity index. A total of 22,686 patients with self-reported hypertension met study eligibility requirements. Of these, 4.51% reported having gout. These patients were older, more likely to be male and have insurance through Veteran Affairs (all p-values < 0.05). Patients with comorbid gout reported lower levels of mental component summary scores (47.25 vs 48.93), PCS scores (39.06 vs 43.78) and health utilities (0.68 vs 0.73; all p-values < 0.05). For both PCS and health utilities, differences between groups exceeded clinically meaningful cutoffs. Sensitivity analyses conducted on PCS and health utilities uncovered slightly smaller, but statistically significant and clinically meaningful, effects (p-values < 0.05). The effect of gout on overall work impairment (23.33 vs 17.40% with and without comorbid gout, respectively) remained after controlling for the Charlson comorbidity index. Significantly greater impairment in daily activities (38.96 vs 28.32%; p < 0.05) was also observed among patients with comorbid gout. Results demonstrate that gout has significant and clinically meaningful impact on work productivity, physical HRQoL and utilities independent of other health conditions.

Keywords::

• gout
• health-related quality of life
• healthcare resource use
• hypertension
• work productivity

Acknowledgements

The authors would like to thank Nikoletta Sternbach (Kantar Health) for her assistance in portions of the data analysis, Jan-Samuel Wagner (Columbia University) for his assistance in portions of the literature review, and Christopher Zacker (Novartis Pharmaceuticals Corporation) for his review and editorial comments on the paper.

Financial & competing interests disclosure

Funding for this research was provided by Novartis Pharmaceuticals Corporation. LM Andrews, KH Kahler and AM Yadao have disclosed that they are employees of Novartis Pharmaceuticals Corporation. M daCosta DiBonaventura has disclosed that he is an employee of Kantar Health. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Kantar Health received payment from Novartis for data analysis and development of the manuscript.