Preventable Hospital Admissions in Persons with Gout: A Population-Based Study

Objectives Ambulatory care sensitive conditions (ACSCs) are a defined set of diagnoses where appropriate ambulatory care prevents or reduces the need for admission to hospital. Hospitalization rates for ACSCs (inclusive of grand mal seizures, chronic lower respiratory diseases, asthma, diabetes, heart failure and pulmonary edema, hypertension, and angina) are used nationally as indicators for health system quality. We aimed to estimate the rates of ACSC hospitalizations in people with gout compared to matched controls. Methods Linked administrative health datasets from the province of Alberta were used to create an incident cohort based on validated ICD codes for gout from years 2002-2023. Controls were selected in a 1:1 ratio matched for age and sex. We used the Canadian Institute for Health Information ACSC ICD-10-CA case definitions to identify hospitalizations from the Discharge Abstract Database as our outcome of interest.[1] We calculated incidence rate ratios (IRR) at 3 and 5 years from the date of the first gout diagnosis using a multivariable regression model adjusting for age, sex, location of residence, and socioeconomic status. Results There were 129,378 individuals with incident gout over the study period (66% male, mean age 71 years, 79% urban, 34% with material and social deprivation). Of these, 42.6% (n=55,085) had at least 1 hospital admission for any reason, with a total of 180,696 unique hospitalizations, compared to 31.2% (n=40,373) of controls with 111,102 unique hospitalizations. ACSC hospitalizations accounted for 12% (n=20,889) of all admissions in persons with gout, compared to 10% (n=10,607) of all admissions in controls. This was driven primarily by hospitalizations for heart failure and pulmonary edema in the gout cohort (50.5%) and chronic lower respiratory diseases in the matched cohort (43.4%). After adjusting for age, sex, location of residence, and socioeconomic status, the IRR for an ACSC hospitalization was increased at 3 years (IRR 1.15, 95% CI 1.09, 1.22) and 5 years (IRR 1.18, 95% CI 1.13, 1.23) in those with gout compared to controls (Table 1). Among individual ACSCs, the IRR for heart failure and pulmonary edema admissions was increased by 34% at 5 years in those with gout (IRR 1.34, 95% CI 1.23, 1.45) relative to controls. Table 1. Incidence rate ratios (95% CI) for Ambulatory Care Sensitive Condition Hospitalizations, in persons meeting the case definition for gout compared to age and sex matched controls Conclusion The risk for potentially preventable hospital admissions is increased in people with gout, primarily driven by heart failure and pulmonary edema. Access to high quality ambulatory care with optimization of comorbidity management is indicated to improve outcomes. References [1.] Canadian Institute for Health Information. https://www.cihi.ca/en/indicatorsambulatory-care-sensitive-conditions-hospitalizations