Modifiable Factors and Incident Gout Across Ethnicity Within a Large Multiethnic Cohort of Older Adults

Objective Gout disproportionately affects older Pacific Islander and Black populations relative to White populations. However, the ethnic-specific determinants remain understudied within these groups, as well as within other ethnicities. We examined gout incidence and associations with behavioral factors, including diet, alcohol, and smoking, within a large multiethnic population of older adults from the Multiethnic Cohort Study, which linked prospective cohort data to Medicare gout claims between 1999–2016.

Methods Using samples of Black (n = 12,370), Native Hawaiian (n = 6459), Japanese (n = 29,830), Latino (n = 17,538), and White (n = 26,067) participants, we conducted multiple Cox regressions, producing hazard ratios (HRs) and 95% CIs.

Results Relative to White individuals, Native Hawaiians had the highest risk of gout (HR 2.21, 95% CI 2.06–2.38), followed successively by Black and Japanese participants, whereas Latino individuals had a lower risk of gout (HR 0.78, 95% CI 0.73–0.83). Alcohol use was associated with an increased risk, with significantly greater effects observed among Japanese participants drinking ≥ 3 drinks per day (HR 1.46, 95% CI 1.27–1.66), or > 5 beers per week (HR 1.29, 95% CI 1.17–1.43), compared to White individuals (P_interaction < 0.001). Former smokers with ≥ 20 pack-years had an increased risk (HR 1.14, 95% CI 1.06–1.22). Higher dietary quality was associated with a decreased gout risk, with the largest effect observed among White participants (HR_Q5vsQ1 0.84, 95% CI 0.79–0.90), whereas vitamin C was weakly associated with a decreased risk of gout only among Japanese individuals (HR 0.91, 95% CI 0.85–0.98).

Conclusion Overall, notable ethnic differences were observed in both gout risk and associations with modifiable behavioral factors. Our findings offer crucial insights that may improve precision in preventing and managing gout.