Gout incidence and management during the COVID-19 pandemic in England, UK: a nationwide observational study using OpenSAFELY.

Background: Gout is the most prevalent inflammatory arthritis, yet one of the worst managed. Our objective was to assess how the COVID-19 pandemic impacted incidence and quality of care for people with gout in England, UK.
Methods: With the approval of National Health Service England, we did a population-level cohort study using primary care and hospital electronic health record data for 17·9 million adults registered with general practices using TPP health record software, via the OpenSAFELY platform. The study period was from March 1, 2015, to Feb 28, 2023. Individuals aged 18-110 years were defined as having incident gout if they were assigned index diagnostic codes for gout, were registered with TPP practices in England for at least 12 months before diagnosis, did not receive prescriptions for urate-lowering therapy more than 30 days before diagnosis, and had not been admitted to hospital or attended an emergency department for gout flares more than 30 days before diagnosis. Outcomes assessed were incidence and prevalence of people with recorded gout diagnoses, incidence of gout hospitalisations, initiation of urate-lowering therapy, and attainment of serum urate targets (≤360 μmol/L).
Findings: From a reference population of 17 865 145 adults, 246 695 individuals were diagnosed with incident gout. The mean age of individuals with incident gout was 61·3 years (SD 16·2). 66 265 (26·9%) of 246 695 individuals were female, 180 430 (73·1%) were male, and 189 035 (90·9%) of 208 050 individuals with available ethnicity data were White. Incident gout diagnoses decreased by 30·9% in the year beginning March, 2020, compared with the preceding year (1·23 diagnoses vs 1·78 diagnoses per 1000 adults). Gout prevalence was 3·07% in 2015-16, and 3·21% in 2022-23. Gout hospitalisations decreased by 30·1% in the year commencing March, 2020, compared with the preceding year (9·6 admissions vs 13·7 admissions per 100 000 adults). Of 228 095 people with incident gout and available follow-up, 66 560 (29·2%) were prescribed urate-lowering therapy within 6 months. Of 65 305 individuals who initiated urate-lowering therapy with available follow-up, 16 790 (25·7%) attained a serum urate concentration of 360 μmol/L or less within 6 months of urate-lowering therapy initiation. In interrupted time-series analyses, urate-lowering therapy prescribing improved modestly during the pandemic, compared with pre-pandemic, whereas urate target attainment was similar.
Interpretation: Using gout as an exemplar disease, we showed the complexity of how health care was impacted during the COVID-19 pandemic. We observed a reduction in gout diagnoses but no effect on treatment metrics. We showed how country-wide, routinely collected data can be used to map disease epidemiology and monitor care quality.
Funding: None.
Competing Interests: Declaration of interests MDR has received honoraria from Eli Lilly, Galapagos, and Menarini; support for attending conferences from Eli Lilly, Pfizer, Janssen, and UCB; and advisory board fees from Biogen. ER has received research funding from the National Institute for Health and Care Research (NIHR), is senior author of the 2017 British Society for Rheumatology gout guideline, and topic advisor to the 2022 National Institute for Health and Care Excellence gout guideline. BG has received research funding from the Laura and John Arnold Foundation, NIHR, NIHR School for Primary Care Research, NHS England, NIHR Oxford Biomedical Research Centre, the Mohn Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, WHO, UK Research and Innovation Medical Research Council, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. AMe has received consulting fees from Induction Healthcare, and is a member of the Royal College of General Practitioners health informatics group and the NHS Digital GP Data Professional Advisory Group, which advises on access to GP Data for Pandemic Planning and Research. AMa has received speaker fees from AbbVie, Galapagos, and MEDACS, and support for attending meetings from UCB and Fresenius. AIR has received fees from Eli Lilly and UCB for attending a conference. SP reports support for attending conferences from Galapagos. EA has received funding to attend meetings from UCB. KB has received grant funding from NIHR and Versus Arthritis/Pfizer, and support to attend conferences from UCB. JML is clinical director for the National Early Inflammatory Arthritis Audit, secretary for the Federation of Joint Royal Colleges of Physicians specialist certificate exam board, and a trustee of the British Society for Rheumatology. SN has received honoraria from Janssen. APC has received grants from Bristol Myers Squibb (BMS); consulting fees from BMS, AbbVie, and GSK/Galvini; and speaker fees from BMS and AbbVie; and is on the executive committee of the European Alliance of Associations for Rheumatology research centre. JBG has received honoraria from AbbVie, BMS, Celgene, Chugai, Gilead Sciences, Janssen, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, Swedish Orphan Biovitrum, and UCB. All other authors declare no competing interests.
(Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)