POS0155 WHAT DRIVES RACIAL DISPARITIES IN GOUT IN THE US? – POPULATION-BASED, SEX-SPECIFIC, CASUAL MEDIATION ANALYSIS

Background Traditionally viewed as a disease of White men, global frequency and disability burden female gout are rising disproportionately to male gout. 1 Moreover, emerging US cohort data suggest hyperuricemia impart larger burdens on Black adults than Whites. 2 These racial disparities may be largely attributable differences in non-genetic, mainly modifiable risk factors e.g., BMI, diet, 3,4 chronic kidney (CKD). However, national-level, general population gout, potential mediators, lacking. Objectives To determine quantify sex-specific mediators prevalence among nationally representative sample adults. Methods Using recent decadal (2007-2016) physician-diagnosed from the National Health Nutrition Examination Survey, we compared contemporary sex- race-specific prevalences conducted sequential causal mediation analysis (adjusting for upstream following pathways) 5 proportion 7 potentially mediating social clinical (see DAG Figure 1): low education, poverty, body mass index (BMI), alcohol, poor quality diet (poor DASH adherence), diuretic use, CKD (eGFR <60 mL/min, using latest equations that do not include coefficient race 6, per Kidney Foundation American Society Nephrology recommendations. ) Results Age standardised was 3.5% 2.0% women, respectively (age-adjusted OR =1.8 [95% CI: 1.3 2.5]), 7.0% 5.4% men =1.3 [1.0 1.6]). Most were more frequent/elevated Blacks Whites, except alcohol consumption, which lower (both sexes). BMI levels poverty higher but similar between men. Largest factor excess cases women accounting 56% difference (independent alcohol), followed by (24%), (17%), (12%) Table 1). 1. Indirect (mediation) effects analysis, association odds WOMEN MEN Effect Estimate (OR), 95% CI Proportion Mediated, % (Mediation) Education (high school or less) 1.01 (0.98 1.03) 2.4% 3.3% Poverty 1.07 (1.04 1.10) 16.9% 1.00 (0.99 1.00) 0.53% Alcohol consumption (# drinks/week, continuous 0.99 (0.96 1.01) -3.4% -4.5% score (continuous; scores = ↓ adherence 1.05 12.0% (1.01 19.8% Body (continuous 1.25 (1.14 1.37) 55.9% 1.03 (1.02 1.04) 11.9% Diuretic use 1.05) 7.6% 1.04 1.06) 14.2% Chronic 1.10 1.16) 23.9% 1.12 (1.08 1.17) 45.6% Direct 0.94 (0.68 1.30) −15.2% 1.02 (0.83 1.26) b 9.2% Total 1.49 (1.12 1.98) 100% 1.29 (1.05 1.57) DASH=Dietary Approaches Stop Hypertension; p=0.52, p=0.83 Among largest mediator (46%), (20%) (14%). (0.5%) mediated smaller proportions women. Mediators closely agreed with results. Conclusion Contrasting historical views, is frequent their counterparts, especially (two-times greater vs. White). Culturally informed efforts reduce these should focus adiposity, quality, while recognising impact References [1]Xia; PMID 31624843 [2]PMID 24335384 [3]Rai BMJ 28487277 [4]Yokose JAMA IM (2022) [5]VanderWeele; 25580377 [6] NEJM 34554658 [7] JASN 34556489 Disclosure Interests Natalie McCormick: None declared, Leo Lu: Chio Yokose: Amit Joshi: Tony Merriman: Kenneth Saag Consultant of: Arthrosi, Atom Bioscience, Horizon Therapeutics, LG Pharma, Mallinkrodt, SOBI, Takeda, Grant/research support from: Shanton, Yuqing Zhang: Hyon Choi Ironwood, Selecta, Horizon, Kowa, Vaxart.