What Drives the Contemporary Black–White Racial Disparities in Gout in the US? Impact of Social Determinants of Health

Abstract

Together with the substantial role of genetic factors, serum urate levels and the occurrence of gout are also heavily driven by environmental and clinical factors, including adiposity, dietary patterns, alcohol, kidney function, and diuretic medication use. These are, in turn, greatly influenced by the social determinants of health, which encompass access to health care, availability of healthy foods, and opportunities for physical activity but also education, income, social norms, and racism, among other forces. Gout-related health disparities have been described for Māori and Pacific people in New Zealand, but racial disparities in gout prevalence and outcomes between Black and White Americans have been under-recognised, and particularly, sex-specific data are scarce. In this article we review evidence from prior cohort studies and contemporary national-level data which show the incidence and prevalence of gout and hyperuricemia in Black adults in the US have come to exceed that in White adults and are disproportionately greater in Black women. Importantly, this emerging disparity can be attributed entirely to social determinants of health, including higher levels of adiposity and poverty in Black women compared to White women and lower kidney function and poorer quality diet among Black men compared to White men. Furthermore, Black patients with gout have received poorer quality gout-related care and experienced higher levels of healthcare use, especially Black women. While identifying targets for culturally safe interventions for addressing risk factor disparities is essential, evidence gaps remain about potential disparities in longer-term outcomes of gout, including cardio-metabolic-kidney endpoints and premature mortality. Sociodemographically diverse, population-based longitudinal cohort studies, research on implementation strategies for improved gout care delivery models for underserved groups, and efforts to minimise structural racism and its effects are key to achieving health equity in gout.