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. 2025 Sep 24;20(9):e0332265.
doi: 10.1371/journal.pone.0332265. eCollection 2025.

Burden, risk factors, and forecasts of gout in BRICS countries, 1990-2021: Insights from the Global Burden of Disease Study 2021

Qizhou Mo  1 , Shufeng Luo  2 , Fengyi Wang  3 , Haiqi Liang  1 , Jiayin Yu  1 , Naikai Liao  1 , Min Qin  4 , Jiwen Cheng  1
Affiliations

Burden, risk factors, and forecasts of gout in BRICS countries, 1990-2021: Insights from the Global Burden of Disease Study 2021

Qizhou Mo et al. PLoS One. .

Abstract

Objectives: To evaluate the temporal trends and projected burden of gout in BRICS (Brazil, Russia, India, China, and South Africa) countries from 1990 to 2021, based on Global Burden of Disease 2021 data, and to explore the contributions of key risk factors.

Methods: Age-standardized prevalence rates (ASPR), years lived with disability rates (ASYR), and case counts were extracted from the GBD Results Tool. Temporal trends were assessed using estimated annual percentage change (EAPC). Joinpoint regression evaluated time-varying changes in ASYR attributable to high BMI (Body Mass Index) and kidney dysfunction. ARIMA models forecasted ASPR and ASYR through 2036.

Results: From 1990 to 2021, ASPR and ASYR increased globally and in all BRICS nations. In 2021, China recorded the highest ASPR and ASYR in males (1232.34 and 38.83 per 100,000, respectively), with EAPC of 1.14 and 1.13. Brazil had the lowest burden. In 2021, China and India reported the highest absolute burdens of gout, with approximately 16.79 million prevalent cases and 525,967 YLDs in China, and 5.32 million prevalent cases and 164,153 YLDs in India. High BMI and kidney dysfunction were key contributors to ASYR, especially in older adults. Forecasts indicate ASPR and ASYR will decline globally by 2036, but rise in Brazil, India, Russia, and South Africa. Chinese males show projected declines, while female rates increase modestly.

Conclusions: The burden of gout is rising across BRICS countries, shaped by aging populations, metabolic risk exposures, and distinct sex-specific trends. These findings highlight the importance of developing locally adapted prevention and control strategies to address this growing challenge.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Temporal trends in ASPR and ASYR of gout in BRICS (Brazil, Russia, India, China, and South Africa) countries and globally, 1990–2021.
A. ASPR in males; B. ASPR in females; C. ASYR in males; D. ASYR in females. ASPR, age-standardized prevalence rates; ASYR, age-standardized years lived with disability rates.
Fig 2
Fig 2. Age-specific number of gout prevalent cases by sex in BRICS (Brazil, Russia, India, China, and South Africa) nations, 1990 and 2021.
A-E: Brazil, Russia, India, China, and South Africa, respectively.
Fig 3
Fig 3. Joinpoint regression analysis of ASYR of gout attributable to high BMI and kidney dysfunction in BRICS (Brazil, Russia, India, China, South Africa) countries, 1990–2021.
ASYR trends attributable to high BMI: A. both sexes, B. males, C. females. ASYR trends attributable to kidney dysfunction: D. both sexes, E. males, F. females. *Indicates a statistically significant annual percent change (APC) at P < 0.05. ASYR, age-standardized years lived with disability rates; BMI: body mass index.
Fig 4
Fig 4. Age-specific YLD rates of gout attributable to high BMI by sex in BRICS (Brazil, Russia, India, China, South Africa) nations in 1990 and 2021.
A–B: Brazil (1990, 2021); C–D: Russia (1990, 2021); E–F: India (1990, 2021); G–H: China (1990, 2021); I–J: South Africa (1990, 2021). YLD, years lived with disability; BMI: body mass index.
Fig 5
Fig 5. Age-specific YLD rates of gout attributable to kidney dysfunction by sex in BRICS (Brazil, Russia, India, China, South Africa) nations in 1990 and 2021.
A–B: Brazil (1990, 2021); C–D: Russia (1990, 2021); E–F: India (1990, 2021); G–H: China (1990, 2021); I–J: South Africa (1990, 2021). YLD, years lived with disability.
Fig 6
Fig 6. Temporal trends (1990–2021) and ARIMA-based forecasts (2022–2036) of gout ASPR in BRICS (Brazil, Russia, India, China, South Africa) nations and globally.
A–B: Global ASPR in males and females; C–D: Brazil; E–F: Russia; G–H: India; I–J: China; K–L: South Africa. ASPR, age-standardized prevalence rates; ARIMA, Autoregressive integrated moving average.
Fig 7
Fig 7. Temporal trends (1990–2021) and ARIMA-based forecasts (2022–2036) of gout ASYR in BRICS (Brazil, Russia, India, China, South Africa) nations and globally.
A–B: Global ASPR in males and females; C–D: Brazil; E–F: Russia; G–H: India; I–J: China; K–L: South Africa. ASYR, age-standardized years lived with disability rates; ARIMA, Autoregressive integrated moving average.
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