Racial and Sex Disparities in Gout Prevalence Among US Adults

Abstract

IMPORTANCE Emerging data suggest gout and hyperuricemia may now be more frequent among Black adults in the US than White adults, especially Black women. However, national-level, sex-specific general population data on racial differences in gout prevalence and potential socioclinical risk factors are lacking. OBJECTIVE To identify sex-specific factors driving disparities between Black and White adults in contemporary gout prevalence in the US general population.

Trends in Prevalence of Gout Among US Asian Adults, 2011-2018

“…We found that the Asian vs White disparity in gout prevalence and serum urate concentrations in the NHANES 2017 to 2018 and those in the UKBB through 2021 increased after accounting for social determinants of health, lifestyle, and clinical factors. This is in striking opposition to the gout disparity observed among Black individuals, which was entirely explained by the same socioclinical and lifestyle factors (ie, nurture), whereas Asian disparities are likely associated with both nature (genetics) and nurture (Westernized environments). Indeed, individuals of Asian ancestry have a higher prevalence of SLC2A9 , ABCG2 , and other urate risk variants, which are key contributors to hyperuricemia and gout .…”

“…The excess burden of gout among Asian adults was replicated in the UK, another prototypical Western country (although with modestly better metabolic health than the US), and in both settings, these disparities strengthened after adjustment for BMI and socioclinical factors. This contrasts the Black vs White gout disparity in the US and likely reflects the combined effects of the higher prevalence of urate risk alleles and exposure to increasingly gout-prone environments among Asian individuals.…”

“…We examined how the temporal trends in gout prevalence and serum urate concentrations within Asian individuals changed with the addition of each covariate (with a significant trend) in regression models. We then determined how the racial differences between Asian and White US individuals in gout prevalence and serum urate concentrations in the 2017 to 2018 cycle changed with the addition of prespecified covariates to the age- and sex-adjusted model, as recently done for disparities among Black US individuals . We started with social factors (low education [high school or less], poverty, and health insurance), then consecutively added alcohol, diet score, and BMI (3 lifestyle factors potentially associated with education and poverty), and finished with diuretics and chronic kidney disease status (clinical factors potentially associated with the other purported risk factors).…”

“…The overall prevalence of gout in the US had more than doubled between the 1960s, 1990s, and late 2008, and the latest prevalence was estimated to be 3.9% (9.2 million adults) . Furthermore, there are racial and ecological disparities in gout disease burden . For example, a recent US nationwide study found that gout was more prevalent among Black individuals than White individuals, and this difference was entirely explained by social determinants of health and clinical factors.…”

Metabolomic and transcriptomic exploration of the uric acid-reducing flavonoids biosynthetic pathways in the fruit of Actinidia arguta Sieb. Zucc.

“…The key cause of primary HUA is a combination of low UA excretion and high UA production. A majority (67%) of UA in the human body is produced by the catabolism of nuclear proteins, nucleic acids, and other substances in the body; the remaining 33% comes from purines in food ( Lai et al., 2021 ; Lee et al., 2022 ; Mccormick et al., 2022 ). Adenosine deaminase (ADA) and xanthine oxidase (XO) are the key enzymes that regulate the production of UA during the catabolism of purine substances to UA.…”