Odds of Achieving Target Serum Uric Acid Levels Among Gout Patients: The Role of Rurality in Outcomes and Treatment Adherence.
Odds of Achieving Target Serum Uric Acid Levels Among Gout Patients: The Role of Rurality in Outcomes and Treatment Adherence.
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DOI：
10.1177/21501319231167379
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发表时间：
2023-01
影响因子：
3.6
通讯作者：
Hardin, James W.
中科院分区：
文献类型：
--
作者：
Sutton, S. Scott;Magagnoli, Joseph;Cummings, Tammy H.;Hardin, James W.
本文的目的是分析与痛风治疗相关的患者结果，包括大都市、小城市或农村县患者的血清尿酸 (sUA) 测量和治疗依从性。我们对开始降尿酸治疗的痛风患者进行了一项药物-疾病队列研究。使用卡方检验和调整后的逻辑回归，对随访 1 年时 sUA<6mg/dL 的患者比例与队列组进行比较。使用覆盖天数比例 (PDC) 计算对降尿酸治疗的依从性。使用 T 检验来比较平均 PDC，并使用调整后的逻辑回归模型来估计 PDC 大于 80% 的几率。该研究总共纳入了 9922 名患者。大多数患者居住在大都市地区（77.4%），其次是小城市地区（11.8%），最后是农村地区（10.8%）。我们发现达到目标 sUA <6mg/dL 的患者比例没有统计学上的显着差异，大城市患者为 37.17%，小城市患者为 38.9%，农村地区为 37.7%，P 值 = .502。达到80%治疗依从性的患者比例在大城市为49.92%，在小城市为51.78%，在农村地区为55.05%，P值 = .005。调整后的回归模型显示，达到目标 sUA 水平或 80% 依从性的比例没有统计学上的显着差异。与农村患者相比，接受痛风治疗的城市患者的痛风结果并不好。未来的研究应考虑基于提供者的干预措施以改善结果。
The goal of this paper was to analyze patient outcomes related to gout treatment including, serum uric acid (sUA) measures and treatment adherence across patients in metropolitan, micropolitan or rural counties. We conducted a drug-disease cohort study among patients with gout initiating urate lowering therapy. The proportion of patients with sUA < 6 mg/dL at 1 year of follow-up is compared over the cohort groups using a chi-square test and adjusted logistic regression. Adherence to urate lowering therapy was calculated using the proportion of days covered (PDC). A T-test was used to compare the average PDC and an adjusted logistic regression model was used to estimate the odds of a PDC greater than 80%. A total of 9922 patients were included in the study. Most patients were in a metropolitan (77.4%) area, followed by micropolitan (11.8%) and finally, (10.8%) in a rural area. We found no statistically significant difference among the proportion of patients achieving target sUA of <6 mg/dL, 37.17% among metropolitan patients, 38.9% among micropolitan patients, and 37.7% for those in a rural area, P-value = .502. The proportion of patients achieving 80% treatment adherence was 49.92% in the metropolitan, 51.78% in the micropolitan, and 55.05% in the rural areas, P-value = .005. Adjusted regression models showed no statistically significant difference in proportions achieving target sUA levels or 80% adherence. Urban patients treated for gout did not have better gout outcomes compared to rural patients. Future research should consider provider-based interventions to improve outcomes.
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