Higher Level of Education Linked to Lower Risk of Gout

A genetically predicted higher level of educational attainment demonstrated a potential protection against gout, according to a study published in Frontiers in Public Health.¹ This association was also influenced by individual physical status (IPS) factors including systolic blood pressure (SBP), lifestyle habits such as alcohol intake and time spent watching television, and body mass index (BMI).

There is increasing evidence indicating a global rise in prevalence and incidence of gout. Some risk factors related to gout include hyperuricemia and environmental factors, including eating purine-rich foods. Previous research has also shown a hypothetical association between decreased educational attainment and an increase in gout. Other data point to obesity and lifestyle factors, such as alcohol consumption, smoking status, and sedentary behavior as risk factors for developing gout.²

“Inequality in educational attainment remains a persistent social challenge implicitly linked to socioeconomic and individual poverty,” wrote a team of investigators from Mindong Hospital Affiliated to Fujian Medical University, Fuan, Fujian Province, China. “Historically, studies have shown that poor educational achievement is a potential catalyst for gout attacks.”

To determine the causal effects of educational attainment on gout risk, as well as of IPS and lifestyle habits, investigators used a novel 2-sample Mendelian randomization (MR) approach. Multivariable MR (MVMR) were used to determine and quantify the mediating effects of IPS and lifestyle habits on the causal relationship between gout risk and education. Education levels, which were self-reported at age ≥30, were analyzed using the Social Science Genetic Association Consortium (SSGAC) database, comprised of 766,345 individuals of European ancestry. Population-level gout data was incorporated from the genome-wide association studies (GWAS) database.

The study was performed in 3 phases: determining the causal impact of education on gout, IPS, and LH; establishing the causal influence of IPS and lifestyle habits on gout; and investigating and quantifying the potential mediating role of IPS and lifestyle habits in the causal relationship between education and gout.

Findings revealed an elevation of educational attainment by one standard deviation, defined as 4.2 years, exhibited a protective effect against gout (odds ratio [OR] .724, 95% confidence interval [CI] .552—.950; P = .020).

Although no causal relationship was observed between smoking and gout (OR = .838, 95% CI = .243–2.891, P = .780), other lifestyle factors were linked to an increased risk of gout. Mediating factors included SBP (OR = 1.020, 95% CI = 1.009–1.031, P = 2.29), BMI (OR = 1.709, 95% CI = 1.227–2.381, P = .002), drinking (OR = 1.454, 95% CI = 1.025–2.061, P = .036), and longer television time (OR = 2.968, 95% CI = 1.525–5.776, P = .001).

After adjusting for educational attainment, higher BMI was associated with a 54.8% increase in gout (OR = 1.548, 95% CI = 1.142–2.097, P = .005), while drinking led to a 47.2% increase (OR = 1.472, 95% CI = 1.037–2.090, P = .031). Further, SBP was linked to a 2.1% increase in gout risk (OR = 1.021, 95% CI = 1.009–1.033, P = .001) and television time was associated with a 150.5% increase in risk (OR = 2.504, 95% CI = .950–6.599, P = .063).

Investigators noted the possibility of horizontal pleiotropy or other direct causal pathways, although the validated MR-Egger regression analysis did not observe any evidence of this. Additionally, generalizability may be limited as the GWAS database was predominantly comprised of patients of European ancestry. Lastly, the mediating proportions of the mediators identified may interact with each other. The joint proportions after accounting for this have not been evaluated.

“For individuals with limited access to educational resources, adopting strategies such as moderating alcohol intake and incorporating regular exercise into their routine to maintain a healthy body mass index and blood pressure may prove effective in preventing gout,” investigators concluded.

References

1. ^{Huang X, Chen X, Liu Q, et al. The relationship between education attainment and gout, and the mediating role of modifiable risk factors: a Mendelian randomization study. Front Public Health. 2024;11:1269426. Published 2024 Jan 8. doi:10.3389/fpubh.2023.1269426}
2. ^{Ragab, G, Elshahaly, M, and Bardin, T. Gout: an old disease in new perspective – a review. J Adv Res. (2017) 8:495–511. doi: 10.1016/j.jare.2017.04.008}