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UBC Theses and Dissertations

Population-based epidemiologic studies of gout in British Columbia, Canada Rai, Sharan Kimberly


Introduction: This thesis contains original analyses aimed at better understanding the burden of gout, an excruciatingly painful form of inflammatory arthritis, in the Canadian context. While gout is increasingly recognized as the most common form of inflammatory arthritis worldwide (e.g., reported prevalence of 3.9% and 2.5% in the United States and United Kingdom, respectively), no Canadian trend data are available. Objectives: 1) To evaluate the contemporary prevalence and incidence of gout over the past decade, as well as gout treatment patterns and comorbidity burden. 2) To evaluate the burden of hospitalized gout and corresponding inpatient costs as compared to rheumatoid arthritis (RA), another inflammatory joint disease known to incur substantial resource use. Methods: To address both objectives, I used PopulationData BC, a large administrative database spanning the province of British Columbia (BC). For Objective 1, I used physician and hospital visits to identify gout cases and estimate the annual trends in prevalence and incidence among the general population. I additionally used data from PharmaNet, BC’s prescription drug database, to examine gout treatment patterns (i.e., urate-lowering therapy, colchicine, glucocorticoids, and non-steroidal anti-inflammatory drugs) over the same time period. For Objective 2, I used hospital diagnoses and procedure codes to assess annual trends in hospitalizations and joint surgeries as well as inpatient costs for both gout and RA. Results: 1) Both the prevalence and incidence of gout have increased over the past decade (i.e., a 59% and 48% increase, respectively), while the prescription of gout treatment remains low. 2) The hospitalization rates for gout have doubled over the past decade, while those for RA have declined by 49%. The inpatient costs also reflected the hospitalization trends, with a 40% decrease in RA hospital costs, while gout costs more than doubled over the study period. Conclusion: Altogether, this thesis provides evidence that the burden of gout in Canada is substantial and increasing. These findings are further contrasted against the hospitalization burden of RA, which has decreased considerably over the same period. This thesis highlights the critical need to improve gout prevention and care to mitigate its rising disease burden in Canada and beyond.

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