Gout is the most common inflammatory arthritis and occurs when hyperuricaemia, sustained elevation of serum urate levels resulting in supersaturation of body tissues with urate, leads to the formation and deposition of monosodium urate crystals in and around the joints. Recent reports of the prevalence and incidence of gout vary widely according to the population studied and methods employed but range from a prevalence of <1% to 6.8% and an incidence of 0.58–2.89 per 1,000 person-years. Gout is more prevalent in men than in women, with increasing age, and in some ethnic groups. Despite rising prevalence and incidence, suboptimal management of gout continues in many countries. Typically, only a third to half of patients with gout receive urate-lowering therapy, which is a definitive, curative treatment, and fewer than a half of patients adhere to treatment. Many gout risk factors exist, including obesity, dietary factors and comorbid conditions. As well as a firmly established increased risk of cardiovascular disease and chronic kidney disease in those with gout, novel associations of gout with other comorbidities have been reported, including erectile dysfunction, atrial fibrillation, obstructive sleep apnoea, osteoporosis and venous thromboembolism. Discrete patterns of comorbidity clustering in individuals with gout have been described. Increasing prevalence and incidence of obesity and comorbidities are likely to contribute substantially to the rising burden of gout.
Gout is a common chronic crystal deposition disorder that affects between <1% and 6.8% of the population depending upon the population studied.
Both prevalence and incidence of gout seem to be rising across the globe.
Management of gout continues to be poor, with fewer than one half of patients receiving definitive ‘curative’ urate-lowering therapy.
Adherence to urate-lowering therapy is often poor and rates of non-persistence are high.
Obesity and comorbidities are important risk factors for gout and are important drivers of its rising prevalence and incidence.
Subscribe to Journal
Get full journal access for 1 year
only $17.42 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Kuo, C. F., Grainge, M. J., Zhang, W. & Doherty, M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat. Rev. Rheumatol. 11, 649–662 (2015).
Wijnands, J. M. et al. Determinants of the prevalence of gout in the general population: a systematic review and meta-regression. Eur. J. Epidemiol. 30, 19–33 (2015).
Robinson, P. C., Taylor, W. J. & Dalbeth, N. An observational study of gout prevalence and quality of care in a national Australian general practice population. J. Rheumatol. 42, 1702–1707 (2015).
Gonzalez-Chica, D. A., Vanlint, S., Hoon, E. & Stocks, N. Epidemiology of arthritis, chronic back pain, gout, osteoporosis, spondyloarthropathies and rheumatoid arthritis among 1.5 million patients in Australian general practice: NPS MedicineWise MedicineInsight dataset. BMC Musculoskelet. Disord. 19, 20 (2018).
Ting, K., Gill, T. K., Keen, H., Tucker, G. R. & Hill, C. L. Prevalence and associations of gout and hyperuricaemia: results from an Australian population-based study. Intern. Med. J. 46, 566–573 (2016).
Pisaniello, H. L. et al. Gout prevalence and predictors of urate-lowering therapy use: results from a population-based study. Arthritis Res. Ther. 20, 143 (2018).
Zhu, Y., Pandya, B. J. & Choi, H. K. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 63, 3136–3141 (2011).
Chen-Xu, M., Yokose, C., Rai, S. K., Pillinger, M. H. & Choi, H. K. Contemporary prevalence of gout and hyperuricemia in the United States and decadal trends: the National Health and Nutrition Examination Survey, 2007–2016. Arthritis Rheumatol. 71, 991–999 (2019).
Rai, S. K. et al. The rising prevalence and incidence of gout in British Columbia, Canada: population-based trends from 2000 to 2012. Semin. Arthritis Rheum. 46, 451–456 (2017).
Health Canada. Arthritis in Canada: an Ongoing Challenge (Health Canada, 2003).
Branco, J. C. et al. Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt – a national health survey. RMD Open 2, e000166 (2016).
Kapetanovic, M. C. et al. Prevalence and incidence of gout in southern Sweden from the socioeconomic perspective. RMD Open 2, e000326 (2016).
Dehlin, M., Drivelegka, P., Sigurdardottir, V., Svard, A. & Jacobsson, L. T. Incidence and prevalence of gout in Western Sweden. Arthritis Res. Ther. 18, 164 (2016).
Wandell, P., Carlsson, A. C. & Ljunggren, G. Gout and its comorbidities in the total population of Stockholm. Prev. Med. 81, 387–391 (2015).
Kinge, J. M., Knudsen, A. K., Skirbekk, V. & Vollset, S. E. Musculoskeletal disorders in Norway: prevalence of chronicity and use of primary and specialist health care services. BMC Musculoskelet. Disord. 16, 75 (2015).
Zobbe, K. et al. Secular trends in the incidence and prevalence of gout in Denmark from 1995 to 2015: a nationwide register-based study. Rheumatology 58, 836–839 (2019).
Zeng, S. Y. et al. Changes in the prevalence of rheumatic diseases in Shantou, China, in the past three decades: a COPCORD study. PLoS ONE 10, e0138492 (2015).
Chen, Y. Z. et al. The prevalence of gout in mainland China from 2000 to 2016: a systematic review and meta-analysis. J. Public Health 25, 521–529 (2017).
Kim, J. W. et al. Prevalence and incidence of gout in Korea: data from the national health claims database 2007-2015. Rheumatol. Int. 37, 1499–1506 (2017).
Al Saleh, J., Sayed, M. E., Monsef, N. & Darwish, E. The prevalence and the determinants of musculoskeletal diseases in Emiratis attending primary health care clinics in Dubai. Oman Med. J. 31, 117–123 (2016).
Courage, U. U. et al. Prevalence of musculoskeletal diseases in a semi-urban Nigerian community: results of a cross-sectional survey using COPCORD methodology. Clin. Rheumatol. 36, 2509–2516 (2017).
Guevara-Pacheco, S. et al. Prevalence of musculoskeletal disorders and rheumatic diseases in Cuenca, Ecuador: a WHO-ILAR COPCORD study. Rheumatol. Int. 36, 1195–1204 (2016).
Wandell, P. et al. Gout in immigrant groups: a cohort study in Sweden. Clin. Rheumatol. 36, 1091–1102 (2017).
Anagnostopoulos, I. et al. The prevalence of rheumatic diseases in central Greece: a population survey. BMC Musculoskelet. Disord. 11, 98 (2010).
Sicras-Mainar, A., Navarro-Artieda, R. & Ibanez-Nolla, J. Resource use and economic impact of patients with gout: a multicenter, population-wide study. Reumatol. Clin. 9, 94–100 (2013).
Elfishawi, M. M. et al. The rising incidence of gout and the increasing burden of comorbidities: a population-based study over 20 years. J. Rheumatol. 45, 574–579 (2018).
Fischer, A. et al. The direct economic burden of gout in an elderly Canadian population. J. Rheumatol. 44, 95–101 (2017).
Kapetanovic, M. C. et al. The risk of clinically diagnosed gout by serum urate levels: results from 30 years follow-up of the Malmo Preventive Project cohort in southern Sweden. Arthritis Res. Ther. 20, 190 (2018).
Aitken, M. J. Developments in Gout Treatment: New Approaches to an Old Disease (Nova, 2017).
Saag, K. G. et al. Lesinurad combined with allopurinol: a randomized, double-blind, placebo-controlled study in gout patients with an inadequate response to standard-of-care allopurinol (a US-based study). Arthritis Rheumatol. 69, 203–212 (2017).
Dalbeth, N. et al. Lesinurad, a selective uric acid reabsorption inhibitor, in combination with febuxostat in patients with tophaceous gout: findings of a phase III clinical trial. Arthritis Rheumatol. 69, 1903–1913 (2017).
Doherty, M. et al. Gout: why is this curable disease so seldom cured? Ann. Rheum. Dis. 71, 1765–1770 (2012).
Kim, J. W., Kwak, S. G. & Park, S. H. Prescription pattern of urate-lowering therapy in Korean gout patients: data from the national health claims database. Korean J. Intern. Med. 33, 228–229 (2018).
Kuo, C. F., Grainge, M. J., Mallen, C., Zhang, W. & Doherty, M. Eligibility for and prescription of urate-lowering treatment in patients with incident gout in England. JAMA 312, 2684–2686 (2014).
Dehlin, M. et al. Factors associated with initiation and persistence of urate-lowering therapy. Arthritis Res. Ther. 19, 6 (2017).
Scheepers, L. E. J. M. et al. Medication adherence among patients with gout: a systematic review and meta-analysis. Semin. Arthritis Rheum. 47, 689–702 (2018).
Scheepers, L. E. J. M. et al. Medication adherence among gout patients initiated allopurinol: a retrospective cohort study in the Clinical Practice Research Datalink (CPRD). Rheumatology 57, 1641–1650 (2018).
McGowan, B., Bennett, K., Silke, C. & Whelan, B. Adherence and persistence to urate-lowering therapies in the Irish setting. Clin. Rheumatol. 35, 715–721 (2016).
Chua, X. H. J. et al. Factors influencing medication adherence in patients with gout: a descriptive correlational study. J. Clin. Nurs. 27, e213–e222 (2018).
Sheng, F., Fang, W., Zhang, B., Sha, Y. & Zeng, X. Adherence to gout management recommendations of Chinese patients. Medicine 96, e8532 (2017).
Spencer, K., Carr, A. & Doherty, M. Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann. Rheum. Dis. 71, 1490–1495 (2012).
Goldfien, R., Pressman, A., Jacobson, A., Ng, M. & Avins, A. A pharmacist-staffed, virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial. Perm. J. 20, 15–234 (2016).
Doherty, M. et al. Efficacy and cost-effectiveness of nurse-led care involving education and engagement of patients and a treat-to-target urate-lowering strategy versus usual care for gout: a randomised controlled trial. Lancet 392, 1403–1412 (2018).
Dalbeth, N. et al. Relationship between serum urate concentration and clinically evident incident gout: an individual participant data analysis. Ann. Rheum. Dis. 77, 1048–1052 (2018).
Evans, P. L. et al. Obesity, hypertension and diuretic use as risk factors for incident gout: a systematic review and meta-analysis of cohort studies. Arthritis Res. Ther. 20, 136 (2018).
Larsson, S. C., Burgess, S. & Michaëlsson, K. Genetic association between adiposity and gout: a Mendelian randomization study. Rheumatology 57, 2145–2148 (2018).
Maglio, C. et al. Effects of bariatric surgery on gout incidence in the Swedish Obese Subjects study: a non-randomised, prospective, controlled intervention trial. Ann. Rheum. Dis. 76, 688–693 (2017).
Teng, G. G., Pan, A., Yuan, J.-M. & Koh, W.-P. Food sources of protein and risk of incident gout in the Singapore Chinese Health Study. Arthritis Rheumatol. 67, 1933–1942 (2015).
Ayoub-Charette, S. et al. Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. BMJ Open 9, e024171 (2019).
Jamnik, J. et al. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open 6, e013191 (2016).
Rai, S. K. et al. The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study. BMJ 357, j1794 (2017).
Chiu, T. H. T., Liu, C.-H., Chang, C.-C., Lin, M.-N. & Lin, C.-L. Vegetarian diet and risk of gout in two separate prospective cohort studies. Clin. Nutr. 39, 837–844 (2020).
Major, T. J., Topless, R. K., Dalbeth, N. & Merriman, T. R. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts. BMJ 363, k3951 (2018).
Rai, S. K., Zhang, Y., Hu, F. B., Pearce, N. & Choi, H. K. The paradox of ubiquitous risk factors for gout. BMJ 363, k3951 (2018).
Choi, H. K. et al. Population impact attributable to modifiable risk factors for hyperuricemia. Arthritis Rheumatol. 72, 157–165 (2020).
Kuo, C.-F., Grainge, M. J., Mallen, C., Zhang, W. & Doherty, M. Comorbidities in patients with gout prior to and following diagnosis: case-control study. Ann. Rheum. Dis. 75, 210–217 (2016).
Jaffe, D. H. et al. Incident gout and chronic kidney disease: healthcare utilization and survival. BMC Rheumatol. 3, 11 (2019).
Roughley, M. et al. Risk of chronic kidney disease in patients with gout and the impact of urate lowering therapy: a population-based cohort study. Arthritis Res. Ther. 20, 243 (2018).
Singh, J. A. & Cleveland, J. D. Gout is associated with a higher risk of chronic renal disease in older adults: a retrospective cohort study of U.S. Medicare population. BMC Nephrol. 20, 93 (2019).
Tan, V. S. et al. The 3-year incidence of gout in elderly patients with CKD. Clin. J. Am. Soc. Nephrol. 12, 577–584 (2017).
Drivelegka, P., Sigurdardottir, V., Svärd, A., Jacobsson, L. T. H. & Dehlin, M. Comorbidity in gout at the time of first diagnosis: sex differences that may have implications for dosing of urate lowering therapy. Arthritis Res. Ther. 20, 108 (2018).
Clarson, L. E. et al. Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK Clinical Practice Research Datalink. Ann. Rheum. Dis. 74, 642–647 (2015).
Abdul Sultan, A. et al. Gout and subsequent erectile dysfunction: a population-based cohort study from England. Arthritis Res. Ther. 19, 123 (2017).
Chen, Y. F. et al. Gout and a subsequent increased risk of erectile dysfunction in men aged 64 and under: a nationwide cohort study in Taiwan. J. Rheumatol. 42, 1898–1905 (2015).
Hsu, C. Y., Lin, C. L. & Kao, C. H. Gout is associated with organic and psychogenic erectile dysfunction. Eur. J. Intern. Med. 26, 691–695 (2015).
Singh, J. A. & Cleveland, J. D. Gout and the risk of incident atrial fibrillation in older adults: a study of US Medicare data. RMD Open 4, e000712 (2018).
Kuo, Y. J. et al. The risk of atrial fibrillation in patients with gout: a nationwide population-based study. Sci. Rep. 6, 32220 (2016).
Kuo, C. F., Grainge, M. J., Mallen, C., Zhang, W. & Doherty, M. Impact of gout on the risk of atrial fibrillation. Rheumatology 55, 721–728 (2016).
Kim, S. C., Liu, J. & Solomon, D. H. Risk of incident atrial fibrillation in gout: a cohort study. Ann. Rheum. Dis. 75, 1473–1478 (2016).
Hasday, J. D. & Grum, C. M. Nocturnal increase of urinary uric acid:creatinine ratio. A biochemical correlate of sleep-associated hypoxemia. Am. Rev. Respir. Dis. 135, 534–538 (1987).
Glantzounis, G. K., Tsimoyiannis, E. C., Kappas, A. M. & Galaris, D. A. Uric acid and oxidative stress. Curr. Pharm. Des. 11, 4145–4151 (2005).
Zhang, Y. et al. Sleep apnea and the risk of incident gout: a population-based, body mass index-matched cohort study. Arthritis Rheumatol. 67, 3298–3302 (2015).
Blagojevic-Bucknall, M. et al. The risk of gout among patients with sleep apnea: a matched cohort study. Arthritis Rheumatol. 71, 154–160 (2019).
Singh, J. A. & Cleveland, J. D. Gout and the risk of incident obstructive sleep apnea in adults 65 years or older: an observational study. J. Clin. Sleep. Med. 14, 1521–1527 (2018).
Wang, Y. et al. Association of gout with osteoporotic fractures. Int. Orthop. 42, 2041–2047 (2018).
Tzeng, H.-E., Lin, C.-C., Wang, I. K., Huang, P.-H. & Tsai, C.-H. Gout increases risk of fracture: a nationwide population-based cohort study. Medicine 95, e4669 (2016).
Paik, J. M. et al. Gout and risk of fracture in women: a prospective cohort study. Arthritis Rheumatol. 69, 422–428 (2017).
Kok, V. C. et al. Gout as a risk factor for osteoporosis: epidemiologic evidence from a population-based longitudinal study involving 108,060 individuals. Osteoporos. Int. 29, 973–985 (2018).
Sultan, A. A. et al. Risk of fragility fracture among patients with gout and the effect of urate-lowering therapy. CMAJ 190, E581–E587 (2018).
Kim, S. C., Paik, J. M., Liu, J., Curhan, G. C. & Solomon, D. H. Gout and the risk of non-vertebral fracture. J. Bone Miner. Res. 32, 230–236 (2017).
Huang, C. C. et al. An independent risk of gout on the development of deep vein thrombosis and pulmonary embolism: a nationwide, population-based cohort study. Medicine 94, e2140 (2015).
Chiu, C. C. et al. Association between previous history of gout attack and risk of deep vein thrombosis – a nationwide population-based cohort study. Sci. Rep. 6, 26541 (2016).
Li, L. et al. Trends of venous thromboembolism risk before and after diagnosis of gout: a general population-based study. Rheumatology 59, 1099–1107 (2020).
Sultan, A. A. et al. Venous thromboembolism in patients with gout and the impact of hospital admission, disease duration and urate-lowering therapy. CMAJ 191, E597–E603 (2019).
Kubota, Y., McAdams-DeMarco, M. & Folsom, A. R. Serum uric acid, gout, and venous thromboembolism: the Atherosclerosis Risk In Communities Study. Thromb. Res. 144, 144–148 (2016).
Jung, J. H. et al. Metabolic syndrome: prevalence and risk factors in Korean gout patients. Korean J. Intern. Med. 33, 815–822 (2018).
Choi, H. K., Ford, E. S., Li, C. & Curhan, G. Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 57, 109–115 (2007).
Tu, F.-Y. et al. Prevalence of gout with comorbidity aggregations in southern Taiwan. Joint Bone Spine 82, 45–51 (2015).
Richette, P., Clerson, P., Périssin, L., Flipo, R.-M. & Bardin, T. Revisiting comorbidities in gout: a cluster analysis. Ann. Rheum. Dis. 74, 142–147 (2015).
Bevis, M., Blagojevic-Bucknall, M., Mallen, C., Hider, S. & Roddy, E. Comorbidity clusters in people with gout: an observational cohort study with linked medical record review. Rheumatology 57, 1358–1363 (2018).
Huang, C.-F. et al. Longitudinal transition trajectory of gouty arthritis and its comorbidities: a population-based study. Rheumatol. Int. 37, 313–322 (2017).
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390, 1211–1259 (2017).
Ng, M. et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384, 766–781 (2014).
Han, G.-M., Michaud, K., Yu, F., Watanabe-Galloway, S. & Mikuls, T. R. Increasing public health burden of arthritis and other rheumatic conditions and comorbidity: results from a Statewide Health Surveillance System, 2007–2012. Arthritis Care Res. 68, 1417–1427 (2016).
Kiadaliri, A. A. & Englund, M. Temporal trends and regional disparity in rheumatoid arthritis and gout hospitalizations in Sweden, 1998–2015. Clin. Rheumatol. 37, 825–830 (2018).
Lim, S. Y. et al. Trends in gout and rheumatoid arthritis hospitalizations in the United States, 1993–2011. JAMA 315, 2345–2347 (2016).
Russell, M. et al. Rising incidence of acute hospital admissions due to gout. J. Rheumatol. 47, 619–623 (2020).
Robinson, P. C., Kempe, S., Tebbutt, I. & Roberts, L. Epidemiology of inpatient gout in Australia and New Zealand: temporal trends, comorbidities and gout flare site. Int. J. Rheum. Dis. 20, 779–784 (2017).
The authors thank L. Hammarbäck and E. Hessman of Biomedical Libraries at Gothenburg University Library, Sweden, for help with the literature search.
Articles for inclusion in this Review were obtained by multiple searches of PubMed, SCOPUS and the Cochrane Database with the search terms categorized as ‘epidemiology-related’ (‘gout’, ‘gouty arthritis’, ‘uric acid’, ‘hyperuricaemia’, ‘tophus’, ‘monosodium urate crystals’, ‘prevalence’, ‘incidence’, ‘relative risks’ and ‘odds ratios’), ‘urate lowering therapy-related’ (‘urate-lowering therapy’, ‘ULT’, ‘allopurinol’, ‘benzbromarone’, ‘febuxostat’, ‘pegloticase’, ‘probenecid’, ‘lesinurad’ and ‘prophylactic treatment/therapy’) and ‘risk factors-related’ (‘hyperuricaemia’, ‘urate’, ‘uric acid’, ‘tophus’, ‘monosodium urate crystals’, ‘obesity’, ‘overweight’, ‘adiposity’, ‘diet’, ‘dietary factors’, ‘food’, ‘comorbidity’, ‘alcoholism’, ‘alcohol abuse’, ‘cancer’, ‘chronic kidney disease’, ‘CKD’, ‘renal disease’, ‘kidney failure’, ‘chronic lung disease’, ‘lung disease’, ‘pulmonary disease’, ‘heart disease’, ‘heart failure’, ‘haematological disease’, ‘anemia’, ‘sickle cell anemia’, ‘polycythemia’, ‘hypertension’, ‘metabolic syndrome’, ‘psoriasis’, ‘thyroid disease’ and ‘comorbid condition’). Only articles published in English and in the period from January 2015 to the end of May 2019 were included.
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Dehlin, M., Jacobsson, L. & Roddy, E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol 16, 380–390 (2020). https://doi.org/10.1038/s41584-020-0441-1
Biomedicine & Pharmacotherapy (2020)
Rheumatology International (2020)
BMC Musculoskeletal Disorders (2020)
<p>Prevalence of Urolithiasis by Ultrasonography Among Patients with Gout: A Cross-Sectional Study from the UP-Philippine General Hospital</p>
Research and Reports in Urology (2020)