Prevalence, incidence and years lived with disability due to gout and its attributable risk factors for 195 countries and territories 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017.

OBJECTIVES To describe the level and trends of point prevalence, annual incidence and years lived with disability (YLDs) for gout and its attributable risk factors in 195 countries and territories from 1990 to 2017 by age, sex and socio-demographic index (SDI; a composite of socio-demographic factors). METHODS Data were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. A comprehensive systematic review on databases and the disease modelled analysis were performed by the GBD Team at Institute for Health Metrics and Evaluation, in collaboration with researchers and experts worldwide, to provide the estimates at global-, regional-, and national-levels during 1990 and 2017. Counts and age-standardised rates per 100,000 population along with 95% uncertainty intervals (UIs) were reported for point prevalence, annual incidence and YLDs. RESULTS Globally, there were approximately 41.2 million (95% UI: 36.7 to 46.1) prevalent cases of gout, with 7.4 million (95% UI: 6.6 to 8.5) incident cases per year and almost 1.3 million (95% UI: 0.87 to 1.8) YLDs in 2017. The global age-standardised point prevalence estimates and annual incidence rates in 2017 were 510.6 (95% UI: 455.6 to 570.3) and 91.8 (95% UI: 81.3 to 104.1) per 100,000, an increase of 7.2% (95% UI: 6.4 to 8.1) and 5.5% (95% UI: 4.8 to 6.3) from 1990, respectively. The corresponding age-standardised YLD rate was 15.9 (95% UI: 10.7 to 21.8) per 100,000, a 7.2% (95% UI: 5.9 to 8.6) increase since 1990. The global point prevalence estimates of gout was higher in males and higher prevalence was seen in older age groupsand increasing with age for both females and males in 2017. The burden of gout was generally highest in developed regions and countries. New Zealand [1394.0 (95% UI: 1290.1 to 1500.9)], Australia [1171.4 (95% UI: 10398.1 to 1322.9)] and United States [996.0 (95% UI: 923.1 to 1076.8)] were the three countries with the highest age-standardised point prevalence estimates of gout in 2017. United States [34.7% (95% UI: 27.7 to 43.1)], Canada [28.5% (95% UI: 21.9 to 35.4)] and Oman [28.0% (95% UI: 21.5 to 34.8)] were the countries with highest increases in age-standardised point prevalence estimates of gout from 1990 to 2017. Globally, high body mass index and impaired kidney function accounted for 32.4% (95% UI: 18.7 to 49.2) and 15.3% (95% UI: 13.5 to 17.1) of YLDs due to gout in the 2017 estimates, respectively. The YLDs attributable to these risk factors were higher in males. CONCLUSIONS The burden of gout increased across the world from 1990 to 2017, with variation in age-standardised point prevalence, annual incidence and YLDs between countries and territories. Besides improving the clinical management of disease, prevention and health promotion in communities to provide basic knowledge of the disease, its risk factors, consequences, and effective treatment options, with tailoring to high risk group such as the middle-aged male population, are crucial to avoid the disease onset, and hence, to decrease the global disease burden.