Gout epidemiology: results from the UK General Practice Research Database, 1990-1999

Abstract

Objective: To examine the epidemiology of gout and gout treatment in the United Kingdom using a large national practice based population.

Methods: Data from the UK General Practice Research Database from 1990 to 1999 were examined. Physician diagnoses and drug codes were used, and trends in gout incidence and treatment examined. Additionally, disease prevalence for the year 1999 was assessed. To examine the association of gout with comorbid disease, the prevalence of select health conditions and drug use was compared with the corresponding prevalences seen in osteoarthritis, adjusting for both age and sex.

Results: From 1 January 1990 to 31 December 1999 overall gout incidence remained relatively stable, ranging from a low of 11.9 cases (95% confidence interval (CI) 11.5 to 12.3) in 1991 to a high of 18.0 cases (95% CI 17.6 to 18.4) per 10 000 patient-years in 1994. Gout prevalence in 1999 was 1.4% with rates approaching 7% in men over the age of 65. Drugs used for the treatment of gout remained constant in prevalent cases with the exception of a significant decline in non-steroidal anti-inflammatory drug use over the 10 year follow up. Compared with patients with osteoarthritis, patients with gout were significantly more likely to have cardiovascular disease, hypertension, diabetes, and chronic renal failure, and were more likely to have used diuretics or ciclosporin, or both.

Conclusion: Although gout is common in the UK, particularly among older men, the incidence of the disease seems to have remained stable during the 1990s.

Figure 1

(A) Overall and sex-specific annual gout incidence (1990–99) among enrolees in the UK GPRD. (B) Annual UK gout incidence (1990–99) by age distribution. 95% CIs (shown with bars) calculated using normal approximation.

Figure 2

Gout prevalence (1999) among enrolees in the UK GPRD. 95% CIs (shown with bars) calculated using normal approximation.

Figure 3

Annual frequency of NSAID, allopurinol, and glucocorticoid use among prevalent patients with gout (n = 63 105) enrolled in the UK GPRD, 1990–1999; frequency of use includes any prescription received within the same calendar year. Colchicine (range 0.9–3.4%) and uricosuric (range 0.8–1.0%) use are not shown. p Value <0.001 for trend for NSAID use among prevalent patients with gout. NSAID use among prevalent patients with osteoarthritis also declined during the period of observation (data not shown) from a high of 63.7% in 1990 to a low of 39.0% in 1999 (p<0.001 for trend).