RACIAL DIFFERENCES IN THE EPIDEMIOLOGY OF GOUT

点击翻译按钮获取中文摘要

Gout is the most common form of inflammatory arthritis in middle-aged men, and results in considerable short-term disability and health care utilization. Furthermore, recent population-based data suggest that the prevalence of gout and asymptomatic hyperuricemia (AHU) is increasing in the United States. However, little is known about the epidemiology of gout and AHU in blacks, and no systematic racial comparisons have been performed. The proposed project will 1) estimate the incidence of gout, 2) determine the distribution of plasma uric acid levels, and 3) identify risk factors for gout and AHU, in comparable populations of black and white men. In addition, a recent study has reemphasized the possible causal association between gout and coronary artery disease (CAD). The data developed in this proposed study will also be analyzed to determine the possible etiologic role of gout in the development of CAD in the two racial groups. The proposed project will include both a nonconcurrent and concurrent prospective cohort design. The white men are participants in the Johns Hopkins Precursors Study (JHPS), who were enrolled as medical students from 1957 to 1964 (N=536). The black men are participants in the Meharry Medical College Cohort Study (MCS, N=423), who were enrolled as medical students from 1957 to 1965. Both cohorts use identical instruments for baseline and follow-up data collection in studying incidence of cardiovascular outcomes. Cases of gout will be identified using physicians' self-report, and validated using published criteria. Plasma uric acid will be measured on specimens to be obtained as part of the above ongoing JHPS and MCS studies. Data will be analyzed using incidence density ratios and techniques of survival analysis, including Cox proportional hazards model. This study will be the first systematic prospective study comparing the incidence of, and risk factors for, gout in black and white men. Furthermore, these cohorts offer a unique opportunity to investigate the potential role of gout as an independent risk factor for CAD in black and white men. Improved understanding of risk factors for gout, and CAD, will allow development and/or refinement of prevention strategies for gout and CAD.