Global cases of gout exceed 41 million with 'alarming rate' of increased burden
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The burden of gout increased around the world from 1990 to 2017, with a total prevalent case count of 41.2 million, and 1.3 million years lived with disability, estimated for 2017, according to data published in Arthritis & Rheumatology.
“Studies have reported data on prevalence and incidence of gout for a number of regions and countries,” Saeid Safiri, PhD, of Tabriz University of Medical Sciences, in Iran, and colleagues wrote. “However, the representation of disease epidemiology is yet to be consolidated for all countries globally.”
“Published research reports arising from the Global Burden of Disease (GBD) Study 2010 described the global burden of gout at regional levels, and stated that more detailed future estimates and updates would be required as the aging population is increasing globally, together with the continuous increase of overall world population,” they added. “A recent study reported the global burden of gout extracted from the GBD 2017 Study, but a number of issues were not clearly addressed. There was no report of gout incidence, and, more importantly, years lived with disability (YLD) associated with the disease burden.”
To analyze the point prevalence, annual incidence and years lived with disability, and corresponding trends, for gout around the world, Safiri and colleagues examined data from the 2017 GBD. According to the researchers, the GBD is the largest study conducted by the Institute of Health Metrics and Evaluation and, in its more recent 2017 update, includes burden estimates and trends for 359 diseases and injuries, across 21 regions and 195 countries and territories, between 1990 and 2017.
For their work, GBD researchers conducted a comprehensive systematic review on databases and the disease modeled analysis, in collaboration with researchers and experts across the globe. For their own study, Safiri and colleagues reported on counts and agestandardized rates, per 100,000 population, along with 95% uncertainty intervals, for point prevalence, annual incidence and years lived with disability.
According to the researchers, there were approximately 41.2 million (95% UI, 36.7-46.1) prevalent cases of gout in the world in 2017, with 7.4 million (95% UI, 6.6-8.5) incident cases per year and nearly 1.3 million (95% UI, 0.87-1.8) years lived with disability.
The global agestandardized point prevalence for 2017 was an estimated 510.6 per 100,000 people (95% UI, 455.6 to 570.3), while the annual incidence rate was 91.8 (95% UI, 81.3-104.1) per 100,000. These two figures represent increases of 7.2% (95% UI, 6.4-8.1) and 5.5% (95% UI, 4.8-6.3), respectively, from 1990.
Meanwhile, the corresponding agestandardized rate of years lived with disability was 15.9 (95% UI, 10.7-21.8) per 100,000, a 7.2% (95% UI, 5.9-8.6) increase since 1990.
Global point prevalence estimates were higher among males, with a higher prevalence in older age groups, increasing with age for both men and women in 2017. Burden was generally highest in developed regions and countries, with New Zealand, Australia and the United States recording with the three highest agestandardized point-prevalence estimates in 2017. In addition, the United States, Canada and Oman had the highest increases in agestandardized point-prevalence estimates from 1990 to 2017. Globally, high BMI and impaired kidney function represented 32.4% and 15.3%, respectively, of all years lived with disability due to gout in the 2017. These risk factors were higher in males.
“The burden of gout increased across the world at an alarming rate from 1990 to 2017,” Safiri and colleagues wrote. “Significant variations in age-standardized point prevalence, annual incidence and YLDs have been observed among countries and territories.”
“The findings highlight the need for public policy intervention through disease prevention programs, for example, targeting middle-aged male populations with an educational program to describe gout, its risk factors, consequences and effective disease management plans,” they added. “More population-based studies on musculoskeletal diseases including gout should be encouraged, especially in less developed countries, to allow a better monitoring of disease burden.”
Perspective
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N. Lawrence Edwards, MD
This international group of investigators identified a doubling of the worldwide prevalence of gout from 20.2 million in 1990 to 41.2 million in 2017. The regional point-prevalence varied greatly with a 4.6-fold difference between the region with the highest prevalence (Australasia) and the lowest (Central Latin America).
The investigators’ attempts to determine the impact of gout on time lived with disability were hampered by little or no data on the contribution of advanced gout with chronic daily symptoms. They were, however, able to determine the impact of gouty flares on disability. The average number of reported flares per year in the gout population was 5.7 with an average duration reported of 6.1 days. This equated to patients with gout suffering for 35 days per year from flares, or 9.4% of their lives. The burden of gout worldwide is increasing at an alarming rate. With the aging of the global population, gout will have a greater impact on health care in public policy.
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