Background
Methods
Study cohort and participants
Exposure of interest
Study outcomes
Covariates and confounders
Statistical analyses
Results
Cohort characteristics
DM only (n = 232,592) | Gout only (n = 71,755) | DM and gout (n = 23,261) | Neither DM nor gout (n = 1,010,893) | |
---|---|---|---|---|
Male sex | 97,041 | 48,305 | 13,192 | 395,608 |
(41.7%) | (67.3%) | (56.7%) | (39.1%) | |
Age group, years | ||||
≤ 50 | 41,844 | 7910 | 1616 | 395,186 |
(18.0%) | (11.0%) | (7.0%) | (39.1%) | |
51–60 | 43,982 | 7589 | 3057 | 125,502 |
(18.9%) | (10.6%) | (13.1%) | (12.4%) | |
61–65 | 30,762 | 6268 | 2611 | 78,983 |
(13.2%) | (8.7%) | (11.2%) | (7.8%) | |
66–70 | 40,974 | 14,044 | 5066 | 121,976 |
(17.6%) | (19.6%) | (21.8%) | (12.1%) | |
71–75 | 30,601 | 12,055 | 4392 | 97,567 |
(13.2%) | (16.8%) | (18.9%) | (9.7%) | |
76–80 | 22,807 | 10,386 | 3227 | 82,298 |
(9.8%) | (14.5%) | (13.9%) | (8.1%) | |
> 80 | 21,620 | 13,501 | 3292 | 108,785 |
(9.3%) | (18.8%) | (14.2%) | (10.8%) | |
Race | ||||
Asian | 6533 | 3270 | 970 | 24,744 |
(2.8%) | (4.6%) | (4.2%) | (2.5%) | |
Black | 34,551 | 10,358 | 4548 | 118,867 |
(14.9%) | (14.4%) | (19.6%) | (11.8%) | |
Hispanic | 14,100 | 1938 | 557 | 70,382 |
(6.1%) | (2.7%) | (2.4%) | (7.0%) | |
Other | 4199 | 934 | 470 | 11,254 |
(1.8%) | (1.3%) | (2.0%) | (1.1%) | |
Missing | 27,372 | 6418 | 1258 | 222,928 |
(11.8%) | (8.9%) | (5.4%) | (22.1%) | |
White | 145,837 | 48,837 | 15,458 | 562,718 |
(62.7%) | (68.1%) | (66.5%) | (55.7%) | |
Comorbidities | ||||
Hypertension | 168,155 | 47,446 | 19,556 | 273,828 |
(72.3%) | (66.1%) | (84.1%) | (27.1%) | |
COPD | 20,835 | 5837 | 2376 | 50,610 |
(9.0%) | (8.1%) | (10.2%) | (5.0%) | |
Chronic kidney disease | 20,078 | 9366 | 5641 | 22,791 |
(8.6%) | (13.1%) | (24.3%) | (2.3%) | |
Peripheral vascular disease | 14,362 | 3850 | 1997 | 22,078 |
(6.2%) | (5.4%) | (8.6%) | (2.2%) | |
Hyperlipidemia | 168,964 | 36,296 | 18,066 | 262,591 |
(72.6%) | (50.6%) | (77.7%) | (26.0%) |
No MI (n = 1,325,037) | Incident MI (n = 13,464) | No stroke (n = 1,328,015) | Incident stroke (n = 10,486) | |
---|---|---|---|---|
Male sex | 548,447 | 5699 | 550,342 | 3804 |
(41.4%) | (42.3%) | (41.4%) | (36.3%) | |
Age group, years | ||||
≤ 50 | 445,916 | 640 | 446,085 | 471 |
(33.7%) | (4.8%) | (33.6%) | (4.5%) | |
51–60 | 179,005 | 1125 | 179,348 | 782 |
(13.5%) | (8.4%) | (13.5%) | (7.5%) | |
61–65 | 117,717 | 907 | 117,917 | 707 |
(8.9%) | (6.7%) | (8.9%) | (6.7%) | |
66–70 | 179,931 | 2129 | 180,550 | 1510 |
(13.6%) | (15.8%) | (13.6%) | (14.4%) | |
71–75 | 142,369 | 2246 | 142,889 | 1726 |
(10.7%) | (16.7%) | (10.8%) | (16.5%) | |
76–80 | 116,375 | 2343 | 116,781 | 1937 |
(8.8%) | (17.4%) | (8.8%) | (18.5%) | |
> 80 | 143,125 | 4073 | 143,846 | 3352 |
(10.8%) | (30.3%) | (10.8%) | (32.0%) | |
Race | ||||
Asian | 35,218 | 299 | 35,269 | 248 |
(2.7%) | (2.2%) | (2.7%) | (2.4%) | |
Black | 166,744 | 1580 | 166,617 | 1707 |
(12.6%) | (11.7%) | (12.6%) | (16.3%) | |
Hispanic | 86,542 | 435 | 86,607 | 370 |
(6.5%) | (3.2%) | (6.5%) | (3.5%) | |
Other | 16,688 | 169 | 16,699 | 158 |
(1.3%) | (1.3%) | (1.3%) | (1.5%) | |
Missing | 257,540 | 436 | 257,627 | 349 |
(19.4%) | (3.2%) | (19.4%) | (3.3%) | |
White | 762,305 | 10,545 | 765,196 | 7654 |
(57.5%) | (78.3%) | (57.6%) | (73.0%) | |
Comorbidities | ||||
Hypertension | 500,421 | 8564 | 502,233 | 6752 |
(37.8%) | (63.6%) | (37.8%) | (64.4%) | |
COPD | 77,833 | 1825 | 78,533 | 1125 |
(5.9%) | (13.6%) | (5.9%) | (10.7%) | |
Chronic kidney disease | 56,131 | 1745 | 56,741 | 1135 |
(4.2%) | (13.0%) | (4.3%) | (10.8%) | |
Peripheral vascular disease | 40,919 | 1368 | 41,446 | 841 |
(3.1%) | (10.2%) | (3.1%) | (8.0%) | |
Hyperlipidemia | 478,544 | 7373 | 480,711 | 5206 |
(36.1%) | (54.8%) | (36.2%) | (49.7%) |
Unadjusted incidence of MI or stroke by age and sex in four cohorts
Group | Females | Males | ||||
---|---|---|---|---|---|---|
Age groups (years) | No. of MI events | Person-years | Incidence rate (/1000 PY) | No. of MI events | Person-years | Incidence rate (/1000 PY) |
Diabetes and gout | ||||||
≤ 50 | 5 | 519.1 | 9.63 | 16 | 1665.0 | 9.61 |
51–60 | 22 | 1463.6 | 15.03 | 45 | 2642.8 | 17.03 |
61–65 | 14 | 1376.8 | 10.17 | 32 | 2103.6 | 15.21 |
66–70 | 51 | 3067.2 | 16.63 | 67 | 4353.8 | 15.39 |
71–75 | 65 | 2992.6 | 21.72 | 83 | 3507.9 | 23.66 |
76–80 | 51 | 2531.1 | 20.15 | 66 | 2303.4 | 28.65 |
> 80 | 106 | 2688.5 | 39.43 | 64 | 1709.0 | 37.45 |
Diabetes only, no gout | ||||||
≤ 50 | 113 | 32,057.2 | 3.52 | 125 | 27,800.2 | 4.50 |
51–60 | 269 | 38,836.8 | 6.93 | 229 | 29,492.3 | 7.76 |
61–65 | 206 | 27,596.4 | 7.46 | 181 | 20,494.1 | 8.83 |
66–70 | 439 | 45,356.6 | 9.68 | 360 | 33,703.8 | 10.68 |
71–75 | 463 | 37,735.6 | 12.27 | 339 | 23,503.7 | 14.42 |
76–80 | 445 | 30,209.4 | 14.73 | 293 | 15,681.8 | 18.68 |
> 80 | 696 | 29,606.4 | 23.51 | 317 | 11,422.9 | 27.75 |
Gout only, no diabetes | ||||||
≤ 50 | 6 | 1177.0 | 5.10 | 36 | 8691.4 | 4.14 |
51–60 | 9 | 2011.3 | 4.47 | 46 | 7845.4 | 5.86 |
61–65 | 8 | 2153.1 | 3.72 | 37 | 5882.7 | 6.29 |
66–70 | 43 | 5861.1 | 7.34 | 132 | 14,896.7 | 8.86 |
71–75 | 53 | 6308.6 | 8.40 | 144 | 12,016.8 | 11.98 |
76–80 | 70 | 6510.9 | 10.75 | 156 | 9253.9 | 16.86 |
> 80 | 247 | 10,232.1 | 24.14 | 221 | 8705.4 | 25.39 |
No gout or diabetes | ||||||
≤ 50 | 178 | 293,997.0 | 0.61 | 161 | 222,722.0 | 0.72 |
51–60 | 277 | 121,761.0 | 2.27 | 228 | 76,284.1 | 2.99 |
61–65 | 238 | 76,628.8 | 3.11 | 191 | 43,196.1 | 4.42 |
66–70 | 528 | 140,311.0 | 3.76 | 508 | 80,566.3 | 6.31 |
71–75 | 614 | 119,092.0 | 5.16 | 485 | 62,948.0 | 7.70 |
76–80 | 810 | 105,226.0 | 7.70 | 452 | 48,350.6 | 9.35 |
> 80 | 1738 | 144,580.0 | 12.02 | 684 | 46,825.3 | 14.61 |
Group | Females | Males | ||||
---|---|---|---|---|---|---|
Age groups (years) | No. of stroke events | Person-years | Incidence rate (/1000 PY) | No. of stroke events | Person-years | Incidence rate (/1000 PY) |
Diabetes and gout | ||||||
≤ 50 | 2 | 507.1 | 3.94 | 5 | 1681.4 | 2.97 |
51–60 | 10 | 1444.4 | 6.92 | 25 | 2629.4 | 9.51 |
61–65 | 17 | 1329.1 | 12.79 | 21 | 2094.0 | 10.03 |
66–70 | 31 | 2960.7 | 10.47 | 47 | 4275.3 | 10.99 |
71–75 | 64 | 2828.7 | 22.63 | 58 | 3392.6 | 17.10 |
76–80 | 50 | 2412.2 | 20.73 | 40 | 2195.6 | 18.22 |
> 80 | 82 | 2543.8 | 32.23 | 44 | 1633.0 | 26.94 |
Diabetes only, no gout | ||||||
≤ 50 | 95 | 31,642.3 | 3.00 | 66 | 27,586.3 | 2.39 |
51–60 | 230 | 37,988.2 | 6.05 | 123 | 29,100.9 | 4.23 |
61–65 | 168 | 26,836.9 | 6.26 | 142 | 20,078.1 | 7.07 |
66–70 | 295 | 43,522.1 | 6.78 | 235 | 32,805.9 | 7.16 |
71–75 | 311 | 35,848.3 | 8.68 | 230 | 22,574.2 | 10.19 |
76–80 | 348 | 28,436 | 12.24 | 189 | 14,887.7 | 12.70 |
> 80 | 578 | 27,758.8 | 20.82 | 171 | 10,827.8 | 15.79 |
Gout only, no diabetes | ||||||
≤ 50 | 4 | 1175.3 | 3.40 | 14 | 8647.9 | 1.62 |
51–60 | 9 | 1964.2 | 4.58 | 29 | 7795.3 | 3.72 |
61–65 | 14 | 2086.0 | 6.71 | 34 | 5772.2 | 5.89 |
66–70 | 44 | 5705.1 | 7.71 | 110 | 14,624.7 | 7.52 |
71–75 | 71 | 6019.3 | 11.80 | 117 | 11,595.8 | 10.09 |
76–80 | 85 | 6172.5 | 13.77 | 132 | 8866.4 | 14.89 |
> 80 | 247 | 9655.8 | 25.58 | 168 | 8324.6 | 20.18 |
No gout or diabetes | ||||||
≤ 50 | 181 | 292,332.0 | 0.62 | 104 | 222,180.0 | 0.47 |
51–60 | 235 | 120,045.0 | 1.96 | 121 | 75,642.6 | 1.60 |
61–65 | 197 | 75,185.7 | 2.62 | 114 | 42,652.2 | 2.67 |
66–70 | 443 | 136,150.0 | 3.25 | 303 | 78,992.1 | 3.84 |
71–75 | 549 | 114,537.0 | 4.79 | 326 | 61,136.1 | 5.33 |
76–80 | 737 | 100,637.0 | 7.32 | 356 | 46,603.7 | 7.64 |
> 80 | 1581 | 138,276.0 | 11.43 | 479 | 44,873.5 | 10.67 |
Gout vs. diabetes as a risk of incident MI or incident stroke
Incident MI HR (95% CI)
p value | Incident stroke HR (95% CI)
p value | |||||
---|---|---|---|---|---|---|
Unadjusted | Age-adjusted | Multivariable-adjusteda
| Unadjusted | Age-adjusted | Multivariable-adjusteda
| |
Gout and diabetes | 1.89 (1.75–2.05) | 1.61 (1.49–1.75) | 1.35 (1.25–1.47) | 1.91 (1.74–2.10) | 1.61 (1.46–1.77) | 1.42 (1.29–1.56) |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 | |
Gout, no diabetes | 1.08 (1.01–1.15) | 0.87 (0.81–0.92) | 0.81 (0.76–0.87) | 1.35 (1.26–1.45) | 1.06 (0.99–1.14) | 1.02 (0.95–1.10) |
p = 0.0187 |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 |
p = 0.1005 |
p = 0.5723 | |
No diabetes, no gout | 0.41 (0.39–0.42) | 0.45 (0.43–0.46) | 0.53 (0.51–0.55) | 0.45 (0.43–0.47) | 0.50 (0.48–0.52) | 0.57 (0.54–0.60) |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 |
p < 0.0001 | |
Diabetes, no gout | Reference | Reference | Reference | Reference | Reference | Reference |