Health care use among patients presenting to emergency department for gout flares in Ontario, Canada: a population-based health systems analysis

Objective — We characterized emergency department (ED) gout visits and identified patient characteristics and health services patterns contributing to ED presentations.

Methods — We conducted a population-based study of ED gout visits in Ontario, Canada between 2014 and 2023. We assessed patient characteristics, encounter rate trends (cumulatively and stratified by age and sex), and healthcare use surrounding ED visits. Among individuals aged ≥66 years, gout-related medication use was examined.

Results — From 2014 to 2023, 125,505 ED gout visits occurred, including 86,824 (69.2%) incident ED cases. Mean age was 59.7 years, with 77.5% male. Individuals with ED gout visits were more likely to live in materially marginalized and less racially diverse neighborhoods. Comorbidity burden was high, driven by hypertension (57.7%) and diabetes (24.0%). ED gout encounters peaked in 2018, with an annual crude rate of 0.99 visits per 1,000 persons (95% CI: 0.97–1.01) and a male-specific rate of 1.56 (95% CI: 1.53–1.59). Older adults (aged 75–84) had the highest rates at 3.01 (95% CI: 2.89–3.15) visits per 1000-persons in 2015 across study years. Within 30-days of ED discharge, 21.3% had gout-specific follow-up visits, 28.3% of patients aged ≥66 years received flare medications, and 10.3% filled an opioid prescription. By 6-months, 38.1% underwent outpatient serum urate testing. Within 90-days, repeat ED visits occurred in 29.9%, with 9.4% specifically for gout.

Conclusion — Gout contributes to a high burden of ED visits, with sub-optimal treatment, poor follow-up and frequent representations. Quality improvement efforts are needed to prevent acute care presentations for gout and improve post-ED management.