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BackgroundData on outcomes for people with gout and COVID-19 are extremely few. Our primary objective was to assess whether gout is a risk factor for diagnosis of COVID-19 and death related to COVID-19. The secondary objectives were to test for sex- and drug-specific differences in risk. MethodsWe used data from the UK Biobank that included 15,560 people with gout. Multivariable-adjusted logistic regression was employed in the following analyses using a case-control study design: Analysis A, to test for association between gout and COVID-19 diagnosis (n=459,837); Analysis B, to test for association between gout and death related to COVID-19 in a case-control cohort of people who died or survived with COVID-19 (n=16,336); Analysis C, to test for association between gout and death related to COVID-19 in the entire UK Biobank cohort (n=459,837); Analysis D, to stratify by prescription of urate-lowering therapy (ULT) and colchicine on the risk of death related to COVID-19 in a subset of the UK Biobank cohort with medication data (n=341,398). FindingsGout was associated with diagnosis of COVID-19 in analysis A (OR=1.2 [1.1 ; 1.3]) but not with risk of death in the COVID-19-diagnosed group in analysis B. In analysis C gout associated with risk of death related to COVID-19 in the unadjusted model (OR=3.9 [3.3 ; 4.7]), in Model 1 adjusted for demographic factors (OR=1.8 [1.5 ; 2.1]) and in the fully adjusted Model 2 (OR=1.3 [1.1 ; 1.6]). In Analysis C risk was higher in women than men in Model 1 adjusted for demographic factors (OR=3.5 [2.4 ; 5.0] and OR=1.5 [1.2 ; 1.8], respectively) with the difference maintained after additional adjustment for eight metabolic co-morbidities (ORMen=1.2 [0.9 ; 1.5], ORWomen=1.9 [1.3 ; 2.9]). There were no statistically significant differences in risk of death related to COVID-19 according to prescription of ULT or colchicine. InterpretationGout is a risk factor for death related to COVID-19 using the UK Biobank cohort with an increased risk in women with gout that was also driven by risk factors outside metabolic co-morbidities of gout. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSThere are no studies investigating the risk of COVID-19 diagnosis and risk of death with COVID-19 in people with gout. Added value of this studyThe findings provide evidence that gout is a risk factor for diagnosis of COVID-19 and that gout is a risk factor for death with COVID-19, independent of included co-morbidities. Women with gout are at a higher risk of death with COVID-19 than men with gout. Implications of the available evidenceThe new evidence demonstrate that gout is a risk factor for death from COVID-19, particularly in women. This information will inform clinical decision-making in people with gout diagnosed with COVID-19. Future research should focus on replicating these findings, including a focus on understanding key factor(s) explaining the increased risk of death with COVID-19 in women with gout.
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ObjectivesTo assess whether gout and / or rheumatoid arthritis (RA) are risk factors for coronavirus disease 19 (COVID-19) diagnosis. To assess whether gout and / or RA are risk factors for death with COVID-19. MethodsWe used data from the UK Biobank. Multivariable-adjusted logistic regression was employed in the following analyses: Analysis A, to test for association between gout or RA and COVID-19 diagnosis (n=473,139); Analysis B, to test for association between gout or RA and death with COVID-19 in a case-control cohort of people who died or survived with COVID-19 (n=2,059); Analysis C, to test for association with gout or RA and death with COVID-19 in the entire UK Biobank cohort (n=473,139) ResultsRA, but not gout, associated with COVID-19 diagnosis in analysis A. Neither RA nor gout associated with risk of death in the COVID-19-diagnosed group in analysis B. However RA associated with risk of death related to COVID-19 using the UK Biobank cohort in analysis C independent of comorbidities and other measured risk factors (OR=1.9 [95% CI 1.2 ; 3.0]). Gout was not associated with death related to COVID-19 in the same UK Biobank analysis (OR=1.2 [95% CI 0.8 ; 1.7]). ConclusionRheumatoid arthritis is a risk factor for death with COVID-19 using the UK Biobank cohort. These findings require replication in larger data sets that also allow inclusion of a wider range of factors. Key messagesInformation on the risk of death from COVID-19 for people with gout and rheumatoid arthritis is scarce. In an analysis of the UK Biobank there is an increased risk of death related to COVID-19 for people with rheumatoid arthritis independent of included co-morbidities, but not gout. The findings need to be replicated in other datasets where the influence of therapies for rheumatoid arthritis can be tested.