P086 Trends in the Incidence and Management of Gout in England: A Nationwide Study using the OpenSAFELY Platform
Authors: Russell Mark D , Massey Jon , Roddy Edward , MacKenna Brian , Bacon Seb , Goldacre Ben , Andrews Colm D , Hickman George , Mehrkar Amir , Mahto Arti , Rutherford Andrew I , Patel Samir , Adas Maryam A , Alveyn Edward , Nagra Deepak , Bechman Katie , Ledingham Jo M , Hudson Joanna , Norton Sam , Cope Andrew , Galloway James 
Published: April 2024

Abstract

Background/Aims
Gout is the most common inflammatory arthritis worldwide, yet one of the worst managed. Few population-level studies have evaluated how the COVID-19 pandemic impacted on incidence, prevalence, management and hospitalisations for people with gout. We investigated this in England using the OpenSAFELY platform.

Methods
With the approval of NHS England, we conducted a population-level cohort study using primary care and hospital data via the OpenSAFELY platform for 17.9 million adults (40% of England’s population). We analysed the following outcomes between 1 March 2015 and 28 February 2023: 1) incidence and prevalence of recorded gout diagnoses; 2) incidence of hospitalisations with primary admission diagnoses of gout; 3) initiation of urate-lowering therapy (ULT); and 4) serum urate target attainment.

Results
From 17.9 million adults, there were 246,695 incident gout diagnoses between March 2015 and February 2023. The mean age of diagnosed patients was 61.3 years; 66,265 (26.9%) were female; and 189,035 (90.9%) of 208,050 with available ethnicity data were White. On a background trend of decreasing gout incidence since 2015, new gout diagnoses fell by 31.0% in the first year of the pandemic (from 1.78 to 1.23 diagnoses per 1,000 adults), relative to pre-pandemic. A partial recovery in gout incidence was seen in the years commencing March 2021 and March 2022, but this remained below pre-pandemic levels. 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, relative to the preceding year (9.58 vs. 13.7 admissions per 100,000 adults). People presenting with gout during the pandemic did not have more severe disease than those presenting pre-pandemic, but did have proportionately fewer comorbidities. Of 228,095 people with incident gout and available follow-up, 66,560 (29.2%) were prescribed ULT within six months of diagnosis. Of 65,305 ULT initiators with available follow-up, 16,790 (25.7%) attained a urate ≤360 micromol/L within six months of ULT initiation. In interrupted time-series analyses, ULT prescribing improved modestly during the pandemic, relative to pre-pandemic, while urate target attainment was similar.

Conclusion
The incidence of recorded gout diagnoses in England decreased markedly during the pandemic. No rebound increase in incidence has been observed as of early 2023, suggesting many people remain undiagnosed as a consequence of the pandemic. For patients who were diagnosed during the pandemic, ULT initiation improved modestly relative to before the pandemic; however, absolute levels of ULT initiation and target attainment remain far below an acceptable standard. Importantly, we showed how country-wide, routinely-collected data can be used to map disease epidemiology and monitor care quality for rheumatological diseases.

Disclosure
M.D. Russell: Honoraria; AbbVie, Biogen, Eli Lilly, Galapagos, Menarini. Grants/research support; from Eli Lilly, Pfizer, Janssen and UCB. J. Massey: None. E. Roddy: None. B. MacKenna: None. S. Bacon: None. B. Goldacre: Grants/research support; Laura and John Arnold Foundation, NIHR, NHS England, Mohn-Westlake Foundation, Wellcome Trust, Good Thinking Foundation, HDRUK, Health Foundation, WHO, MRC, Asthma UK, BLF, National Core Studies. C.D. Andrews: None. G. Hickman: None. A. Mehrkar: Other; former employee and interim Chief Medical Officer of NHS Digital, RCGP representative on GP Data Professional Advisory Group to NHS Digital. A. Mahto: Honoraria; AbbVie, Galapagos. Grants/research support; Educational support from Eli Lilly. A.I. Rutherford: Grants/research support; Educational support from Eli Lilly. S. Patel: None. M.A. Adas: None. E. Alveyn: None. D. Nagra: None. K. Bechman: Grants/research support; Educational support from UCB, and Grants from Versus Arthritis/Pfizer. J.M. Ledingham: Other; BSR President, secretary for The Federation of Joint Royal Colleges of Physicians Specialist Certificate Exam Board, and a trustee of BSR. J. Hudson: None. S. Norton: None. A. Cope: Honoraria; BMS, AbbVie, GSK/Galvini. Grants/research support; BMS. J. Galloway: Honoraria; Abbvie, Biovitrum, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi, and UCB.