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Gout was once a 'king's disease', now it's ruled by poverty and disparity

Ethnic and gender differences in gout prevalence may be due to differences in diet, kidney health, and other key risk factors, a cross-sectional study finds.

Age normalized based on JAMA Network Open . In black men, the age-standardized prevalence of gout was 7.0%, compared with 5.4% in white men (age-adjusted OR 1.26, 95% CI 1.02-1.55).

However, Dr. Natalie McCormick of Massachusetts General Hospital in Boston and colleagues report that all risk factors for gout are more common in black adults than in white adults.

The association between race and gout lost statistical significance after adjusting for poverty, diet, BMI, and chronic kidney disease in women and diet and chronic kidney disease in men.

“These findings suggest that gout is no longer exclusive to wealthy white men (i.e. “King’s disease”) – if at all – while emphasizing the social determinants of health, these factors could serve as targets to reduce these disparities in the general population,” warn the authors.

Recent data upend conventional epidemiological expectations, suggesting a greater burden of gout n black men, black women, and white women, the authors explain. They add that there is also a disproportionate increase in the global incidence of gout and the disability it causes compared with gout in men.

Studies have shown an association between gout flares and the risk of myocardial infarction and stroke, lasting 2 months after flare.

One potential solution is to address the issue of diet quality.

“[Dietary Approaches to Stop Hypertension] DASH-style diet (compared to a typical U.S. diet) to reduce serum uric acid levels has been demonstrated in randomized clinical trials, and a prospective cohort The study reported an inverse association between DASH adherence (based on total energy intake) and clinical endpoints of gout events,” McCormick and colleagues wrote. “However, higher DASH adherence was also associated with higher food costs; U.S. adults living in poverty had lower DASH adherence scores than those with higher incomes, as did black adults compared to white adults , there is evidence that the relative cost of achieving DASH compliance is higher among black adults than white adults.”

“Therefore,” the researchers continued, “aiming to promote healthy eating patterns interventions, such as DASH or other modalities described in the Dietary Guidelines for Americans, and to reduce barriers to adherence, including for those receiving SNAP benefits (even if their dietary quality tends to be poorer), may reduce racial disparities in the prevalence of gout and hyperuricemia, especially among women.”

In their study, hyperuricemia ( The age-adjusted prevalence of premonitory gout) was also higher in black individuals:

  • Black and white women: 10.5% vs. 5.6% (age-adjusted OR 2.00, 95% CI 1.62-2.47)
  • black vs. white men: 11% vs. 7.8% (age-adjusted) OR 1.39 95% CI 1.15-1.68)

McCormick and colleagues’ cross-sectional analysis used the 2007 to Nationally representative survey data for consecutive cycles of the 2016 National Health and Nutrition Examination Survey (NHANES). Data on gout status and serum urate levels were collected, and participants’ self-reported black or white race was collected. The onset of gout was assessed by asking participants if a doctor had told them they had gout.

Of the 18,693 participants, 3,304 black women (mean age 44.8 years), 6,195 white women (mean age 49.8 years), 3,085 black men (mean age 43.6 years) and 6,109 white males (mean age 48.2 years). Temporal causality and potential unmeasured confounders. Finally, reported racial differences may be influenced by racism or other resulting factors.

The authors concluded that addressing obesity, kidney disease, improving diet quality and recognizing the role of poverty in gout could help narrow these disparities.


    James Lopilato is a staff writer for Medpage Today. He covers a variety of topics currently being explored in medical scientific research.


This study was funded by the National Institutes of Health, the Canadian Institutes of Health Research, and the Rheumatology Research Foundation.

McCormick reports receiving funding from the Canadian Institutes of Health Research and the National Institutes of Health.



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