title: Sex differences in gout epidemiology: evaluation and treatment.
abstract: BACKGROUND
  Little is known about the characteristics, evaluation and treatment of women with gout.
  
  
  OBJECTIVE
  To examine the epidemiological differences and differences in treatment between men and women in a large patient population.
  
  
  METHODS
  The data from approximately 1.4 million people who were members of seven managed care plans in the USA for at least 1 year between 1 January 1999 and 31 December 2003 were examined. Adult members who had pharmacy benefits and at least two ambulatory claims specifying a diagnosis of gout were identified. In addition, men and women who were new users of urate-lowering drugs (ULDs) were identified to assess adherence with recommended surveillance of serum urate levels within 6 months of initiating urate-lowering treatment.
  
  
  RESULTS
  A total of 6133 people (4975 men and 1158 women) with two or more International Classification of Disease-9 codes for gout were identified. As compared with men with gout, women were older (mean age 70 (SD 13) v 58 (SD 14), p<0.001) and had comorbidities and received diuretics more often (77% v 40%; p<0.001). Only 37% of new users of urate-lowering treatment had appropriate surveillance of serum urate levels post-initiation of urate-lowering treatment. After controlling for age, comorbidities, gout treatments, number of ULD dispensings and health plan, women were more likely (odds ratio 1.36, 95% confidence interval 1.11 to 1.67) to receive the recommended serum urate level testing.
  
  
  CONCLUSIONS
  Women with gout were older, had greater comorbidities and more often used diuretics and received appropriate surveillance of serum urate levels, suggesting that the factors leading to gout as well as monitoring of treatment are very different in women and men.
authors.affiliation: Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA 01655, USA. HarroldL@ummhc.org
authors.forename: L R
authors.initials: LR
authors.lastname: Harrold
authors.forename: R A
authors.initials: RA
authors.lastname: Yood
authors.forename: T R
authors.initials: TR
authors.lastname: Mikuls
authors.forename: S E
authors.initials: SE
authors.lastname: Andrade
authors.forename: J
authors.initials: J
authors.lastname: Davis
authors.forename: J
authors.initials: J
authors.lastname: Fuller
authors.forename: K A
authors.initials: KA
authors.lastname: Chan
authors.forename: D
authors.initials: D
authors.lastname: Roblin
authors.forename: M A
authors.initials: MA
authors.lastname: Raebel
authors.forename: A
authors.initials: A
authors.lastname: Von Worley
authors.forename: R
authors.initials: R
authors.lastname: Platt
authors.forename: K G
authors.initials: KG
authors.lastname: Saag
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000008:administration & dosage; D016903:Drug Monitoring / Q000592:standards; D004363:Drug Utilization / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D006073:Gout / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006074:Gout Suppressants / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014527:Uric Acid / Q000097:blood
chemical_list: D004232:Diuretics; D006074:Gout Suppressants; D014527:Uric Acid