The risk of Sjogren's syndrome in the older adults with gout: A medicare claims study - 08/03/19

Doi : 10.1016/j.jbspin.2019.01.022

Jasvinder A. Singh ^a,^b,^c,^⁎ , John D. Cleveland ^b
^a Medicine Service, Veterans Affairs (VA) Medical Center, 700 19th Street S, Birmingham, 35233 AL, USA
^b Department of Medicine at the School of Medicine, University of Alabama at Birmingham, 1720 Second avenue South, Birmingham, 35294-0022 AL, USA
^c Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, 1720 Second avenue South, Birmingham, 35294-0022 AL, USA

^⁎Corresponding author at: University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, 35294-0022 AL USA.University of Alabama at Birmingham, Faculty Office Tower 805B510 20th Street SBirminghamAL35294-0022USA

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Highlights

•	Gout was independently associated with 1.7-fold higher risk of a new diagnosis of SS in adults 65 years or older.
•	Subgroup analyses by age, race, and gender showed no significant differences in association of gout with SS.
•	Among adults 65 years or older, women were 5-times more likely than men to have a new diagnosis of SS.
•	Compared to older adults with no comorbidities, those with 2 or more comorbidities, were 1.7-times more likely to be diagnosed with SS.

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Abstract

Objectives

In the absence of previous studies, our objective was to assess whether gout was associated with an increase or decrease in the risk of Sjogren's Syndrome (SS) in older adults, 65 years or older.

Methods

We used the 5% Medicare claims from 2006–2012. A multivariable Cox regression model assessed the association of gout with incident SS adjusting for age, sex, race, Charlson–Romano comorbidity index, and the use of medications for cardiovascular diseases (statins, beta-blockers, diuretics, ACE-inhibitors) and gout (allopurinol, febuxostat). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated.

Results

There were 3,186 new cases of SS in the study cohort with crude incidence rates of SS of 30/100,000 person-years in patients without gout and 49/100,000 person-years in patients with gout. Multivariable-adjusted analyses showed that gout was independently associated with a higher hazard ratio of SS of 1.73 (95% CI, 1.45, 2.06). Sensitivity analyses that substituted continuous Charlson–Romano comorbidity index score with categorized score (model 2) or individual comorbidities plus three common cardiovascular diseases (hypertension, hyperlipidemia, and coronary artery disease; model 3), confirmed the main study findings with minimal attenuation of hazard ratio, 1.70 (95% CI, 1.43, 2.02) and 1.48 (95% CI, 1.25, 1.77), respectively. Younger age, female sex, White race and higher comorbidity score were associated with a higher hazard of SS.

Conclusions

Gout was associated with more than 1.7-fold higher risk of incident SS in adults 65 years or older. This finding needs to be reproduced and the underlying mechanisms for this association need further study.

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Keywords : Sjogren's syndrome, Gout, Medicare, Older adults, Risk factor