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

Abstract

ImportanceGout disparities among Black individuals in the US have recently been explained by socioclinical factors; however, no information is available among Asian individuals living in Western countries, despite their disproportionately worsening metabolic health.ObjectiveTo determine the prevalence of gout and serum urate concentrations according to race and ethnicity and to explore the association of social determinants of health and clinical factors.Design, Setting, and ParticipantsThis is a population-based, cross-sectional analysis. Data from a nationally representative sample of US adults were obtained from the National Health and Nutrition Examination Survey (NHANES) (2011-2018) in which Asian race data were collected (primary). Data from the UK Biobank (2006-2021) were used for replication of the Asian vs White differences. Data analysis was performed from December 2021 to September 2022.Main Outcomes and MeasuresRace-specific gout prevalence and serum urate levels.ResultsA total of 22 621 participants from NHANES (2011-2018) were included in the analysis (mean [SD] age, 49.8 [17.8] years; 10 948 male participants [48.4%]). In 2017 to 2018, gout affected 12.1 million US individuals, with its crude prevalence increasing from 3.6% (95% CI, 2.8%-4.5%) in 2011 to 2012 to 5.1% (95% CI, 4.2%-5.9%) in 2017 to 2018 (P for trend = .03); this trend was no longer significant after age adjustment (P for trend = .06) or excluding Asian individuals (P for trend = .11). During the same period, age- and sex-adjusted prevalence among Asian Americans doubled from 3.3% (95% CI, 2.1%-4.5%) to 6.6% (95% CI, 4.4%-8.8%) (P for trend = .007) to numerically exceed all other racial and ethnic groups in 2017 to 2018, with age- and sex-adjusted odds ratio (ORs) of 1.61 (95% CI, 1.03-2.51) and a socioclinical factor–adjusted multivariable OR of 2.62 (95% CI, 1.59-4.33) for Asian vs White individuals. The latest age- and sex-adjusted gout prevalence among US individuals aged 65 years and older was 10.0% among White individuals and 14.8% among Asian individuals (including 23.6% of Asian men). Serum urate concentrations also increased between 2011 and 2018 among US Asian individuals (P for trend = .009). The Asian vs White disparity was also present in the UK Biobank.Conclusions and RelevanceThe findings of this study suggest that the prevalence of gout among Asian individuals numerically surpassed that for all other racial and ethnic groups in 2017 to 2018. This Asian vs White disparity did not appear to be associated with socioclinical factors.

Secular trend of gout incidence in the UK: an age-period-cohort analysis

“…One study reported that Asian Americans had a slightly lower prevalence of gout than American White, but their prevalence of gout was doubled over 6 years and became even higher than that of American White, indicating that both genetic and environmental factors play roles in the development of gout. 42 Future studies examining the incidence rate of gout according to racial/ethnic origin in the UK could help to identify risk factors and their interaction on the secular trend of gout.…”

Cardiometabolic Health in Asian American Children

“…Because two-thirds of the Asian adolescents in our sample were US born, we speculate that their higher cardiometabolic risk was dually influenced by genetics and by epigenetic changes due to lifestyle influences. This dual influence provides more clarity on the racial disparity of Asian American adults for conditions such as gout which has doubled in prevalence from 2011 to 2018 [26]. Studies have found individuals with Asian heritages to be genetically disposed to elevated uric acid levels and when combined with Western diets rich in purines and sedentary lifestyles; thus, the risk of complications such as hyperuricemia, gout, and cardiovascular risk are further elevated in Asian Americans [27,28].…”

Serum Urate and Recurrent Gout

“…These factors affect serum urate levels and may be confounders of the associations studied here. Race and ethnicity were included because previous studies reported higher rates of gout in Black and Asian individuals compared with White individuals …”

“…Gout affects more than 12 million adults in the US . Acute gout is typically episodic and associated with severe pain, reduced quality of life, and a transient increase in major cardiovascular and venous thrombotic events .…”