title: Mortality due to coronary heart disease and kidney disease among middle-aged and elderly men and women with gout in the Singapore Chinese Health Study.
abstract: OBJECTIVE
  Whether the link between gout and mortality is causal or confounded by lifestyle factors or comorbidities remains unclear. Studies in Asia are warranted due to the rapid modernisation of the locale and ageing of the population.
  
  
  METHODS
  The association between gout and mortality was examined in a prospective cohort, the Singapore Chinese Health Study, comprising 63 257 Singapore Chinese individuals, aged 45-74 years during the enrolment period of 1993-8. All enrollees were interviewed in person on lifestyle factors, current diet and medical histories. All surviving cohort members were contacted by telephone during 1999-2004 to update selected exposure and medical histories (follow-up I interview), including the history of physician-diagnosed gout. Cause-specific mortality in the cohort was identified via record linkage with the nationwide death registry, up to 31 December 2009.
  
  
  RESULTS
  Out of 52 322 participants in the follow-up I interview, 2117 (4.1%) self-reported a history of physician-diagnosed gout, with a mean age at diagnosis of 54.7 years. After a mean follow-up period of 8.1 years, there were 6660 deaths. Relative to non-gout subjects, subjects with gout had a higher risk of death (HR 1.18; 95% CI 1.06 to 1.32), and specifically from death due to coronary heart disease (CHD) (HR 1.38, 95% CI 1.10 to 1.73) and kidney disease (HR 5.81, 95% CI 3.61 to 9.37). All gout-mortality risk associations were present in both genders but the risk estimates appeared higher for women.
  
  
  CONCLUSIONS
  Gout is an independent risk factor for mortality, and specifically for death due to CHD and kidney disease.
authors.affiliation: University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore.
authors.forename: Gim Gee
authors.initials: GG
authors.lastname: Teng
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Ang
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.forename: Mimi C
authors.initials: MC
authors.lastname: Yu
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
mesh_terms: D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006073:Gout / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality*; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology