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Prevalence and incidence of gout

Clinical bottom line

Gout occurs more frequently in men than women, at older age, with higher levels of uric acid, and in association with hypertension.


In a search for studies on the prevalence and incidene of gout, Bandolier found four primary studies that seemed relevant. Details of the papers, including references, place and time of the study, study populations and results are given in Table 1. These are not the only studies, and additional studies are being sought (July 2002).

Table 1: Studies of prevalence and incidence of gout.

Reference

Place and time

Study population

Hyperuricaemia

Gout incidence

Gout prevalence

AP Hall et al. Epidemiology of gout and hyperuricemia. A long term population study. Am J Med 1967 42: 27-37 Framingham, Mass
1950s and 1960s
2283 men and 2844 women aged 30-59, free of CHD at initial examination. Mean age 44 years at inception, 58 years at prevalence 22% of men had seum uric acid >6 mg/dL on at least one occasion, and 5% had levels of 7 mg/dL or greater. For this cohort, peak incidence was one new attack per 1000 per year One or more attacks of gouty arthritis over 12 years in 1.5% (2,8% men, 0.4% women). Prevalence at age 44 was 0.25%. Prevalence increased with serum uric acid.
WJ Currie. Prevalence and incidence of the diagnosis of gout in Great Britain. Ann Rheumatic Dis 1979 38: 101-106. England, Scotland, Wales
1971-1975
45 practices with about 0.7% of the population (259,000 persons)   About 0.3 per 1000 per year 2.6 per 1000 (1975 GB)
3.0 per 1000 England
2.1 per 1000 Wales
1.3 per 1000 Scotland
1.0 per 1000 women aged 15+
6.1 per 1000 men aged 15+
CM Harris et al. The prevalence and prophylaxis of gout in England. J Clin Epidemiol 1995 9: 1153-1158. England
1991
40 practices with 300,000 persons     9.5 per 1000 women
16.4 per 1000 men
T Grodzicki et al. Incidence of diabetes and gout in hypertensive patients during 8 years of follow up. J Hum Hypetens 1997 11: 583-585. UK
1983-1989
2295 hypertensive and 2280 controls   Men:
controls 0.16%
no diuretic 0.63%
diuretic 1%
Women:
controls 0.05%
no diuretic 0.07%
diuretic 0.12%
 

Serum uric acid

Gouty arthritis occurred much more frequently with increasing uric acid concentrations. Figure 1 shows the information from the Framingham study, where no women had uric acid levels above 8 mg/dL.

Figure 1: Gout and serum uric acid


Age and sex

Gout (or gouty arthritis) occurs more frequently in men than women, and with increasing age. Figure 2 shows the data from Great Britain from 1971 to 1975, and Figure 3 the data from England in 1991.

Figure 2: Gout with age and sex - Great Britain


Figure 2: Gout with age and sex - England 1991


Prescribing allopurinol

In England in 1991, about half the patients with gout were prescribed allopurinol, about the same proportion in men and women overall, but few younger women were prescribed allopurinol (Figure 4).

Figure 4: Allopurinol for gout in England in 1991


Hypertension

Anopther English study examined the incidence of gout in hypertensive men and women over eight years (Table 1). The incidnece was low in hypertensive women and controls, but in hypertensive men were four times more likely to develop gout (relative risk 3.9; 95% confidence interval 1.6 to 9.7) when not on a diuretic, and six times more likely when using a duiretic (relative risk 6.3; 2.4 to 17).