The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years

doi:10.3899/jrheum.170806

. 2018 Apr;45(4):574-579.

doi: 10.3899/jrheum.170806. Epub 2017 Dec 15.

The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years

Mohanad M Elfishawi^{1

2}, Nour Zleik^{1

2}, Zoran Kvrgic^{1

2}, Clement J Michet Jr^{1

2}, Cynthia S Crowson^{3

4}, Eric L Matteson^{1

2}, Tim Bongartz^{3

4}

Affiliations

¹ From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
² M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University.
³ From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA. Tim.Bongartz@Vanderbilt.edu crowson@mayo.edu.
⁴ M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University. Tim.Bongartz@Vanderbilt.edu crowson@mayo.edu.

PMID: 29247151
PMCID: PMC5880714
DOI: 10.3899/jrheum.170806

The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years

Mohanad M Elfishawi et al. J Rheumatol. 2018 Apr.

. 2018 Apr;45(4):574-579.

doi: 10.3899/jrheum.170806. Epub 2017 Dec 15.

Authors

Mohanad M Elfishawi^{1

2}, Nour Zleik^{1

2}, Zoran Kvrgic^{1

2}, Clement J Michet Jr^{1

2}, Cynthia S Crowson^{3

4}, Eric L Matteson^{1

2}, Tim Bongartz^{3

4}

Affiliations

¹ From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
² M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University.
³ From Department of Rheumatology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt; Division of Rheumatology, Mayo Clinic College of Medicine; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, New York; Division of Rheumatology, Augusta University, Atlanta, Georgia; Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA. Tim.Bongartz@Vanderbilt.edu crowson@mayo.edu.
⁴ M.M. Elfishawi, MD, Internal Medicine Resident, Icahn School of Medicine at Mount Sinai; N. Zleik, MD, Internal Medicine Resident, Division of Rheumatology, Augusta University; Z. Kvrgic, CCRP, Study coordinator, Mayo Clinic; C.J. Michet Jr MD, Consultant, Mayo Clinic; C.S. Crowson, MS, Associate Professor, Mayo Clinic; E.L. Matteson, MD, MPH, Consultant, Mayo Clinic; T. Bongartz, MD, MS, Vanderbilt University. Tim.Bongartz@Vanderbilt.edu crowson@mayo.edu.

PMID: 29247151
PMCID: PMC5880714
DOI: 10.3899/jrheum.170806

Abstract

Objective: To examine the incidence of gout over the last 20 years and to evaluate possible changes in associated comorbid conditions.

Methods: The medical records were reviewed of all adults with a diagnosis of incident gout in Olmsted County, Minnesota, USA, during 2 time periods (January 1, 1989-December 31, 1992, and January 1, 2009-December 31, 2010). Incident cases had to fulfill at least 1 of 3 criteria: the American Rheumatism Association 1977 preliminary criteria for gout, the Rome criteria, or the New York criteria.

Results: A total of 158 patients with new-onset gout were identified during 1989-1992 and 271 patients during 2009-2010, yielding age- and sex-adjusted incidence rates of 66.6/100,000 (95% CI 55.9-77.4) in 1989-1992 and 136.7/100,000 (95% CI 120.4-153.1) in 2009-2010. The incidence rate ratio was 2.62 (95% CI 1.80-3.83). At the time of their first gout flare, patients diagnosed with gout in 2009-2010 had higher prevalence of comorbid conditions compared with 1989-1992, including hypertension (69% vs 54%), diabetes mellitus (25% vs 6%), renal disease (28% vs 11%), hyperlipidemia (61% vs 21%), and morbid obesity (body mass index ≥ 35 kg/m²; 29% vs 10%).

Conclusion: The incidence of gout has more than doubled over the recent 20 years. This increase together with the more frequent occurrence of comorbid conditions and cardiovascular risk factors represents a significant public health challenge.

Keywords: COMORBIDITY; EPIDEMIOLOGY; GOUT; INCIDENCE.

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Figures

**Figure 1**
Incidence of gout among adult (age ≥ 18 years) Olmsted County, Minnesota residents in 1989–1992 and 2009–2010 based on the earliest date of fulfillment of 1977 American Rheumatism Association, Rome or New York criteria according to age and sex.

See this image and copyright information in PMC

Comment in

A Changing Landscape of Gout: Comorbidity Matters.
Kuo CF. Kuo CF. J Rheumatol. 2018 Apr;45(4):454-455. doi: 10.3899/jrheum.171446. J Rheumatol. 2018. PMID: 29606645 No abstract available.

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References

1. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63:3136–41. - PubMed
1. Portis AJ, Laliberte M, Tatman P, Moua M, Culhane-Pera K, Maalouf NM, et al. High prevalence of gouty arthritis among the Hmong population in Minnesota. Arthritis Care Res. 2010;62:1386–91. - PubMed
1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35. - PMC - PubMed
1. Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002;29:2403–6. - PubMed
1. Wallace KL, Riedel AA, Joseph-Ridge N, Wortmann R. Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population. J Rheumatol. 2004;31:1582–7. - PubMed

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[1] Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63:3136–41. - PubMed

[2] Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63:3136–41. - PubMed

[3] Portis AJ, Laliberte M, Tatman P, Moua M, Culhane-Pera K, Maalouf NM, et al. High prevalence of gouty arthritis among the Hmong population in Minnesota. Arthritis Care Res. 2010;62:1386–91. - PubMed

[4] Portis AJ, Laliberte M, Tatman P, Moua M, Culhane-Pera K, Maalouf NM, et al. High prevalence of gouty arthritis among the Hmong population in Minnesota. Arthritis Care Res. 2010;62:1386–91. - PubMed

[5] Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35. - PMC - PubMed

[6] Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35. - PMC - PubMed

[7] Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002;29:2403–6. - PubMed

[8] Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002;29:2403–6. - PubMed

[9] Wallace KL, Riedel AA, Joseph-Ridge N, Wortmann R. Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population. J Rheumatol. 2004;31:1582–7. - PubMed

[10] Wallace KL, Riedel AA, Joseph-Ridge N, Wortmann R. Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population. J Rheumatol. 2004;31:1582–7. - PubMed

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The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years

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