Unadjusted and adjusted analyses of patients with gout for achievement and maintenance of target SU of < 6 mg/dl.
| Characteristics | Achieved and Maintained Target SU, Episodes = 7462 | Did Not Achieve and Maintain Target SU, Episodes = 10,861 | Unadjusted Model, OR (95% CI) | Multivariable-Adjusted Model, OR (95% CI) |
|---|---|---|---|---|
| Male sex (ref, female) | 7388 (99.0) | 10,772 (99.2) | 1.17 (0.85–1.16) | 1.31 (0.94–1.82) |
| Race | ||||
| White | 4889 (65.5) | 6706 (61.7) | REF | REF |
| Black | 1645 (22.1) | 2615 (24.1) | 0.88 (0.82–0.95) | 1.02 (0.93–1.11) |
| Hispanic | 314 (4.2) | 606 (5.6) | 0.72 (0.62–0.83) | 0.80 (0.68–0.94) |
| Other | 374 (5.0) | 637 (5.9) | 0.80 (0.70–0.93) | 0.74 (0.64–0.86) |
| Unknown | 240 (3.2) | 297 (2.7) | 1.09 (0.91–1.31) | 1.02 (0.84–1.24) |
| Age, mean (SD) | 67.9 (10.8) | 66.8 (11.4) | 1.01 (1.01–1.01) | 1.01 (1.01–1.01) |
| Marital status | ||||
| Married | 4253 (57.0) | 6010 (55.3) | REF | REF |
| Divorced | 1702 (22.8) | 2481 (22.8) | 0.97 (0.90–1.05) | 1.02 (0.94–1.10) |
| Single | 787 (10.5) | 1382 (12.7) | 0.79 (0.72–0.88) | 0.86 (0.77–0.96) |
| Widowed | 696 (9.3) | 946 (8.7) | 0.86 (0.52–1.43) | 0.97 (0.86–1.09) |
| Unknown | 24 (0.3) | 42 (0.4) | 1.05 (0.94–1.17) | 0.96 (0.57–1.64) |
| Deyo-Charlson comorbidities | ||||
| Myocardial infarction | 7179 (96.2) | 10,367 (95.5) | 0.81 (0.70–0.95) | 0.98 (0.83–1.16) |
| Coronary heart disease | 938 (12.6) | 2317 (21.3) | 0.53 (0.48–0.57) | 0.64 (0.58–0.70) |
| Peripheral vascular disease | 741 (9.9) | 1230 (11.3) | 0.87 (0.78–0.96) | 0.96 (0.86–1.07) |
| Cerebrovascular disease | 697 (9.3) | 1042 (9.6) | 0.97 (0.88–1.08) | 1.01 (0.90–1.13) |
| Dementia | 40 (0.5) | 57 (0.5) | 0.99 (0.65–1.49) | 0.91 (0.59–1.41) |
| Chronic pulmonary disease | 1376 (18.4) | 2262 (20.8) | 0.86 (0.80–0.93) | 0.99 (0.91–1.07) |
| Rheumatologic disease | 233 (3.1) | 297 (2.7) | 1.14 (0.95–1.36) | 1.11 (0.92–1.34) |
| Peptic ulcer disease | 157 (2.1) | 182 (1.7) | 1.26 (1.01–1.57) | 1.24 (0.98–1.56) |
| Mild liver disease | 65 (0.9) | 138 (1.3) | 0.67 (0.49–0.90) | 0.63 (0.45–0.90) |
| Diabetes | 2705 (36.3) | 4651 (42.8) | 0.77 (0.73–0.82) | 0.89 (0.82–0.95) |
| Diabetes with complications | 840 (11.3) | 1616 (14.9) | 0.74 (0.68–0.81) | 1.00 (0.90–1.11) |
| Paraplegia | 35 (0.5) | 41 (0.4) | 1.29 (0.81–2.04) | 1.38 (0.85–2.25) |
| Renal disease | 644 (8.6) | 1579 (14.5) | 0.57 (0.51–0.62) | 0.64 (0.58–0.72) |
| Malignancy | 982 (13.2) | 1461 (13.5) | 0.98 (0.89–1.07) | 0.88 (0.80–0.97) |
| Severe liver disease | 26 (0.4) | 38 (0.4) | 1.03 (0.62–1.71) | 1.41 (0.78–2.57) |
| Malignant neoplasm without specification of site | 53 (0.7) | 87 (0.8) | 0.88 (0.62–1.24) | 0.66 (0.45–0.96) |
| AIDS | 37 (0.5) | 59 (0.5) | 0.90 (0.60–1.37) | 0.96 (0.62–1.49) |
| Provider specialty1 | ||||
| Rheumatology | 596 (8.0) | 749 (6.9) | REF | REF |
| Other | 6866 (92.0) | 10,112 (93.1) | 0.85 (0.76–0.95) | 0.77 (0.68–0.87) |
| Region of country | ||||
| Midwest | 803 (10.8) | 995 (9.2) | REF | REF |
| Northeast | 1358 (18.2) | 1752 (16.1) | 0.98 (0.87–1.11) | 0.87 (0.76–1.00) |
| Mid-Atlantic | 2126 (28.5) | 2100 (28.6) | 0.87 (0.77–0.97) | 0.96 (0.83–1.11) |
| South | 1416 (19.0) | 2427 (22.4) | 0.73 (0.65–0.82) | 0.76 (0.66–0.88) |
| West | 1759 (23.6) | 2586 (23.8) | 0.85 (0.76–0.96) | 0.89 (0.78–1.03) |
| Affiliated with university (ref, no) | 6774 (90.8) | 9971 (91.8) | 0.87 (0.78–0.97) | 0.98 (0.84–1.13) |
| Outpatient clinic type | ||||
| VAMC | 4620 (61.9) | 6841 (63.0) | REF | REF |
| CBOC | 1335 (17.9) | 1802 (16.6) | 1.08 (0.99–1.17) | 1.00 (0.92–1.10) |
| Other | 1210 (16.2) | 1781 (16.4) | 1.00 (0.91–1.08) | 1.01 (0.92–1.11) |
| VAMC and CBOC | 297 (4.0) | 437 (4.0) | 0.98 (0.84–1.15) | 0.89 (0.75–1.05) |
| Operating bed size | ||||
| > 200 | 1216 (16.3) | 1651 (15.2) | REF | REF |
| ≤ 50 | 930 (12.5) | 1248 (11.5) | 1.14 (1.04–1.26) | 1.05 (0.93–1.19) |
| 51–100 | 2830 (37.9) | 4032 (37.1) | 1.17 (1.06–1.29) | 1.07 (0.95–1.20) |
| 101–200 | 2486 (33.3) | 3930 (36.2) | 1.01 (1.03–1.18) | 1.17 (1.08–1.26) |
| Means test2 | ||||
| Most needy but not service-connected | 2685 (36.0) | 4085 (37.6) | REF | REF |
| Most needy and service-connected | 3227 (43.3) | 4728 (43.5) | 1.04 (0.97–1.11) | 1.01 (0.81–1.26) |
| Not most needy | 1255 (16.8) | 1621 (14.9) | 1.16 (1.06–1.28) | 0.99 (0.89–1.09) |
| Other | 295 (4.0) | 426 (3.9) | 1.02 (0.87–1.20) | 0.95 (0.80–1.13) |
| Duration of gout, mean (SD) | 2.1 (2.2) | 2.0 (2.1) | 1.02 (1.01–1.04) | 0.98 (0.97–1.00) |
| Preindex SU level, mg/dl | ||||
| < 6 | 1237 (17.8) | 512 (5.0) | 2.76 (2.44–3.11) | 2.80 (2.48–3.17) |
| 6 to < 8 | 1816 (26.1) | 2072 (20.1) | REF | REF |
| 8 to < 10 | 2637 (37.8) | 4280 (41.5) | 0.70 (0.65–0.76) | 0.72 (0.66–0.78) |
| 10 to < 12 | 1010 (14.5) | 2559 (24.8) | 0.45 (0.41–0.50) | 0.49 (0.45–0.54) |
| ≥ 12 | 270 (3.9) | 881 (8.6) | 0.35 (0.30–0.41) | 0.44 (0.38–0.52) |
Data are n (%) unless otherwise indicated. Bold text denotes statistically significant OR.
↵1 Provider specialty: “Other” category includes non-rheumatologist physician, physician assistant, or advanced nurse practitioner; numbers were too small to separate physician assistant or advanced nurse practitioner.
↵2 Means test is an assessment of socioeconomic status of a veteran. Rheumatologic diseases include systemic lupus erythematosus, systemic sclerosis, polymyositis, polymyalgia rheumatica, rheumatoid lung, and rheumatoid arthritis. Adjusted model: includes patient factors such as age (in yrs), sex, race/ethnicity (white, Hispanic, black or African American, other, unknown), BMI, marital status, Deyo-Charlson index medical comorbidities, healthcare access including distance to nearest VAMC, percent service connection, means test, duration of gout, and preindex SU level. Physician factors include provider specialty (rheumatologists vs non-rheumatologist). System factors include location of the VA facility (rural vs urban), affiliation to a teaching hospital, outpatient clinic type, VA facility bed size (≤ 50, 51–100, 101–200, and > 200) and region (mid-Atlantic, Midwest, Northeast, South, and West). Unique patients = 7309 for patients who achieved and maintained target SU (with 7462 episodes) and 10,389 for patients (with 10,861 episodes) who did not. C statistic for the adjusted model was 0.66. SU: serum urate; BMI: body mass index; VAMC: VA Medical Center clinic; CBOC: community-based outpatient clinic.