Table_1_Incident Gout: Risk of Death and Cause-Specific Mortality in Western Sweden: A Prospective, Controlled Inception Cohort Study.docx

BackgroundExcess mortality in gout has been attributed to cardiovascular diseases (CVD). Considering the decline in CVD mortality in the general population, we wanted to evaluate overall mortality in gout and cause-specific contributions to mortality beyond CVD and temporal trends.
MethodsAll incident cases of gout between 2006 and 2015 in western Sweden and 5 population controls per case matched for age, sex, and county were identified. Comorbidities were identified for 5 years preceding the index date. Follow-up ended at death, migration, or end of study on December 2017. Effect of gout on death risk was calculated using COX regression on the whole population and stratified by sex, adjusted for demographics, and comorbidities. Death incidence rates were compared between the two time periods, 2006–2010 and 2011–2015.
ResultsWe identified 22,055 cases of incident gout and 98,946 controls, median age (Q1, Q3) 69–68 (57, 79/56, 78) years and 67.6–66.5% males. Except for dementia, all comorbidities were significantly more common at baseline among gout cases. Overall, the risk for death in incident gout was neither increased overall nor in men, but women had a 10% elevated risk. In adjusted models for cause-specific mortality, death from CVD, renal disease, and digestive system diseases were significantly increased in the total gout population while death from dementia, cancer, and lung diseases were significantly decreased. There were no significant differences in overall incident death rate ratios between cases and controls in the two time periods examined.
ConclusionsAn increased risk for CVD, renal disease, and diseases of the digestive system in patients with gout highlights the importance of addressing CVD risk factors in gout management. Gout was associated with reduced mortality from dementia, which may have implications on urate lowering therapy and possible effects on dementia risk.

Background 痛风患者的超额死亡率既往被归因于心血管疾病（CVD）。鉴于普通人群中心血管疾病死亡率呈下降趋势，本研究旨在评估痛风患者的全因死亡率、心血管疾病以外的死因特异性死亡贡献，以及死亡率的时间变化趋势。
Methods 本研究纳入2006年至2015年瑞典西部地区的所有新发痛风病例，按年龄、性别与所在县匹配1:5的人群对照。收集索引日期前5年的合并症信息。随访终止于患者死亡、迁出或2017年12月研究结束。采用COX回归（Cox Proportional Hazards Regression）分析痛风对全人群死亡风险的影响，并按性别分层，校正人口统计学特征与合并症。比较2006–2010与2011–2015两个时间段的死亡发病率。
Results 本研究共纳入22055例新发痛风患者与98946名对照人群；痛风组中位年龄（四分位间距）为69岁（57~79岁，对照组为68岁（56~78岁），男性占比分别为67.6%与66.5%。除痴呆外，痛风患者基线时的所有合并症患病率均显著更高。总体而言，新发痛风患者的全因死亡风险未出现整体升高，男性患者亦无显著升高，但女性患者的死亡风险升高10%。在死因特异性死亡率的校正模型中，痛风总体人群因心血管疾病、肾脏疾病及消化系统疾病导致的死亡风险显著升高，而因痴呆、癌症及肺部疾病导致的死亡风险显著降低。在所分析的两个时间段中，病例组与对照组的全因死亡发生率比无显著差异。
Conclusions 痛风患者罹患心血管疾病、肾脏疾病及消化系统疾病的风险升高，提示在痛风管理中需重视心血管疾病危险因素的防控。痛风与痴呆相关死亡率降低存在关联，这一发现可能对降尿酸治疗及痴呆风险的潜在影响具有临床指导意义。