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Gout in the Hmong in the United States

Wahedduddin, Salman MBBS*; Singh, Jasvinder A. MBBS, MPH*†; Culhane-Pera, Kathleen A. MD, MA; Gertner, Elie MD

JCR: Journal of Clinical Rheumatology: September 2010 - Volume 16 - Issue 6 - p 262-266
doi: 10.1097/RHU.0b013e3181eeb487
Original Article

Objective: To compare characteristics of gout in Hmong patients versus whites, and examine if Hmong ethnicity is associated with risk of tophaceous gout.

Methods: A retrospective chart review of Hmong and White patients with gout in a large health care system (Health Partners) in St. Paul, Minnesota, from January 2001 to March 2008, to compare clinical characteristics and risk factors for gout. Multivariable-adjusted hierarchical logistic regressions examined the association of Hmong ethnicity with risk of tophaceous gout, adjusting for age, sex, hypertension, diuretic use, and kidney function.

Results: The analytic dataset consisted of 89 Hmong patients and 84 White controls, all of whom had ethnicity confirmed, an International Classification of Diseases, ninth revision code for gout and had at least 2 physician-documented diagnoses of gout. The Hmong group was younger (58.3 vs. 66.3 years, P = 0.04), had an earlier onset of symptoms (37.4 vs. 55.0 years, P < 0.001) and higher mean serum uric acid levels during follow-up (9.1 vs. 7.6 mg/dL, P ≤ 0.001). Hmong had higher rates of tophaceous gout (31.5% vs. 10.7%, P = 0.001), including hand tophi (21.3% vs. 3.6%, P < 0.001). In multivariable analyses that adjusted for age, sex, hypertension, diuretic, use, and kidney function, Hmong ethnicity was significantly associated with risk of tophaceous gout, with odds ratio 4.3 (95% confidence interval: 1.5, 12.2).

Conclusion: Hmong patients have an earlier onset of gout symptoms. Hmong race is an independent risk factor for tophaceous gout. Future studies need to examine whether genetic or other comorbid factors predict this higher risk of more severe gout in Hmong.

Hmong people in Minnesota have earlier onset and more tophaceous gout than Caucasians in the same area. Mechanisms for this more severe gout need study.

From the *Division of Rheumatology, University of Minnesota Medical School, Minneapolis, MN; †Division of Rheumatology, VA Medical Center, Minneapolis, MN; ‡West Side Community Health Services, Saint Paul, MN; and §Section of Rheumatology, Regions Hospital and HealthPartners Medical Group, Saint Paul, MN.

Supported by the HealthPartners Research Foundation, Institute of Medical Education and the National Institutes of Health Clinical and Translational Science Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research); from TAP Pharmaceuticals (to J.A.S.); Savient and Allergan pharmaceuticals for other investigator-initiated research.

Current address (J.A.S.): VA Medical Center and University of Alabama, Birmingham, AL.

Correspondence: Elie Gertner, MD, Internal Medicine 11107E, Regions Hospital, 640 Jackson St, St. Paul, MN 55101. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.