Sex Differences in Clinical Features in Gout: A Nationwide Retrospective Cohort Study

<b>Background:</b> Patients with gout have several coexisting conditions that impact mortality. We analyzed the differences in clinical manifestations among Korean patients with gout and compared the causes of death based on sex using data from the Korean National Health Insurance Service-National Sample Cohort database. <b>Methods:</b> We included adults with gout receiving urate-lowering therapy (ULT) from 2002 until 2019. The clinical features and causes of death were compared between male and female patients. Multivariate Cox regression was performed to identify the risk factors contributing to all-cause mortality. <b>Results:</b> The results showed that female patients were older at the start of ULT and had more comorbidities. The most common cause of death among all patients with gout was chronic kidney disease (CKD). When observed separately by sex, lung cancer is the leading cause in males, versus CKD in females. Multivariate Cox analysis showed that old age at ULT start, low body mass index (BMI), current smoking, diabetes, CKD, cerebrovascular disease, malignancy, and low hemoglobin were significant risk factors for all-cause mortality in males; however, old age at ULT start, low BMI, CKD, malignancy, and low hemoglobin were significant risk factors in females. <b>Conclusions:</b> The clinical features and cause of death were different between male and female patients with gout, suggesting that treatment strategies for gout should be established differently depending on sex.