Analysis of the trends of gout disease burden in China from 1990 to 2021 and age-period-cohort model

doi:10.11958/20252445

Abstract

Abstract:

Objective To analyze the temporal trends of gout disezse burden in China from 1990 to 2021, and construct an age?period?cohort (APC) model to explore the independent effects of age, period, and birth cohort on epidemiological indicators, and predict the future burden of gout disease in China from 2022 to 2035. Methods Data on gout disease burden in China during 1990—2021 were extracted from the Global Burden of Disease (GBD) 2021 database. Joinpoint regression analysis was used to assess temporal trends. The APC model was applied to evaluate the age, period and cohort effects on prevalence risk and disability-adjusted life years (DALYs). A Bayesian age-period-cohort (BAPC) model was employed to project the age-standardized prevalence rate (ASPR) and age-standardized DALY rate (ASDR) of gout in China from 2022 to 2035. Results From 1990 to 2021, the incidence, prevalence and DALYs of gout in China all increased substantially, with overall rising trends in the age-standardized incidence rate (ASIR), ASPR and ASDR. Compared with 1990, the incidence, prevalence and DALYs in 2021 increased by 160.45%, 181.12%, and 175.93%, respectively, while their age-standardized rates increased by 23.74%, 26.48% and 25.89%. Joinpoint regression analysis revealed that average annual percentage changes (AAPCs) of 0.73% for ASIR, 0.82% for ASPR and 0.80% for ASDR during 1990-2021. In 2021, the number of cases and DALYs reached their peaks in males aged 55-59 years and females aged 65-69 years. Both prevalence and DALY rates increased steadily with age, with marked rises starting at age 30 in men and age 40 in women. Overall, males showed higher prevalence, DALYs and corresponding rates than those of females across all age groups. APC model results indicated that the age effect, period effect and cohort effects on prevalence and DALY rates presented an overall upward tread. Decomposition analysis showed that population aging contributed the most to the increase in incidence and DALYs from 1990 to 2021. BAPC projections suggested that by 2035, the ASPR and ASDR of gout in China reached 890.50 per 100,000 and 27.26 per 100,000, respectively. Conclusion The ASPR and ASDR of gout in China are projected to continue increasing from 2022 to 2035. Targeted public health strategies for high-risk populations are urgently needed to reduce the growing burden of gout.

Key words: gout, global burden of disease, prevalence, disability-adjusted life years, joinpoint regression analysis, age-period-cohort model

CLC Number:

R589.7，R181.32

Figures/Tables 7

References 30

[1]	FITZGERALD J D. Gout[J]. Ann Intern Med, 2025, 178(3):ITC33-ITC48. doi:10.7326/ANNALS-24-03951.
[2]	初吉燕, 田竞, 付笛语, 等. AIM2炎症小体在急性痛风性关节炎中的表达及意义[J]. 天津医药, 2024, 52(5):518-522.
	CHU J Y, TIAN J, FU D Y, et al. Expression and significance of AIM2 inflammasome in patients with acute gouty arthritis[J]. Tianjin Med J, 2024, 52(5):518-522. doi:10.11958/20231205.
[3]	TIMSANS J, PALOMÄKI A, KAUPPI M. Gout and hyperuricemia:A narrative review of their comorbidities and clinical implications[J]. J Clin Med, 2024, 13(24):7616. doi:10.3390/jcm13247616.
[4]	JIN S, WANG Y, YAN S, et al. Global burden of gout and its changing trends and predictions in China:An analysis based on Global Burden of Disease Study 2021[J]. Chin Med J(Engl), 2025. doi:10.1097/CM9.0000000000003631. [Online ahead of print].
[5]	XIE S, XIAO H, XU L, et al. A comprehensive analysis of trends in the burden of gout in China and globally from 1990 to 2021[J]. Sci Rep, 2025, 15(1):3310. doi:10.1038/s41598-025-86090-z.
[6]	MA L, WANG J, MA L, et al. The link between hyperuricemia and diabetes:insights from a quantitative analysis of scientific literature[J]. Front Endocrinol(Lausanne), 2024,15:1441503. doi:10.3389/fendo.2024.1441503.
[7]	CLEGG L X, HANKEY B F, TIWARI R, et al. Estimating average annual per cent change in trend analysis[J]. Stat Med, 2009, 28(29):3670-3682. doi:10.1002/sim.3733.
[8]	LUO Z, HE Y, MA G, et al. Years of life lost due to premature death and their trends in people with malignant neoplasm of female genital organs in Shanghai, China during 1995-2018: a population based study[J]. BMC Public Health, 2020, 20(1):1489. doi:10.1186/s12889-020-09593-6.
[9]	BU T, TANG D, LIU Y, et al. Trends in dietary patterns and diet-related behaviors in China[J]. Am J Health Behav, 2021, 45(2):371-383. doi:10.5993/AJHB.45.2.15.
[10]	LIU Y, DENG W, WEI F, et al. Recent advances in the application of foodborne substances in hyperuricemia[J]. J Agric Food Chem, 2024, 72(50):27639-27653. doi:10.1021/acs.jafc.4c07267.
[11]	KIM H, DO H, SON C N, et al. Effects of genetic risk and lifestyle habits on gout:A Korean cohort study[J]. J Korean Med Sci, 2025, 40(2):e1. doi:10.3346/jkms.2025.40.e1.
[12]	YANG Y, XIAN W, WU D, et al. The role of obesity,type 2 diabetes,and metabolic factors in gout:A Mendelian randomization study[J]. Front Endocrinol (Lausanne), 2022,13:917056. doi:10.3389/fendo.2022.917056.
[13]	CHANG Y, PARK J Y, SONG T J. Association between the triglyceride/high-density lipoprotein(TG/HDL)ratio and incidence of gout:A nationwide cohort study[J]. Front Endocrinol(Lausanne), 2024,15:1453458. doi:10.3389/fendo.2024.1453458.
[14]	LAI S W, HWANG B F, KUO Y H, et al. Risk of gout flare after medication: prescription symmetry sequence analysis[J]. Clin Rheumatol, 2024, 43(3):1183-1188. doi:10.1007/s10067-024-06891-x.
[15]	FUJII W, YAMAZAKI O, HIROHAMA D, et al. Gene-environment interaction modifies the association between hyperinsulinemia and serum urate levels through SLC22A12[J]. J Clin Invest, 2025, 135(10):e186633. doi:10.1172/JCI186633.
[16]	IM P K, KARTSONAKI C, KAKKOURA M G, et al. Hyperuricemia,gout and the associated comorbidities in China:findings from a prospective study of 0.5 million adults[J]. Lancet Reg Health West Pac, 2025,58:101572. doi:10.1016/j.lanwpc.2025.101572.
[17]	ZHU M, WANG X, PENG Z, et al. The role of the estimated glomerular filtration rate and body roundness index in the risk assessment of uric acid-lowering therapy-resistant gout in U.S. adults: evidence from the National Health and Nutrition Examination Survey(2007-2018)[J]. Ren Fail, 2025, 47(1):2441398. doi:10.1080/0886022X.2024.2441398.
[18]	HAO X, WANG A. The status quo and influencing factors of self-management behavior in patients with recurrent gout in China:A cross-sectional study[J]. Patient Prefer Adherence, 2025, 19:1793-1806. doi:10.2147/PPA.S528000.
[19]	CHUNG M K, KIM S S, CHEON Y H, et al. Patient perspectives and preferences regarding gout and gout management:Impact on adherence[J]. J Korean Med Sci, 2021, 36(32):e208. doi:10.3346/jkms.2021.36.e208.
[20]	方珈文, 冯天元, 周志衡, 等. 1990—2019年中国痛风疾病负担趋势及未来十年预测研究[J]. 中国全科医学, 2024, 27(2):245-252.
	FANG J W, FENG T Y, ZHOU Z H, et al. Trend analysis of gout burden in China from 1990 to 2019 and prediction for the next ten years[J]. Chinese General Practice, 2024, 27(2):245-252. doi:10.12114/j.issn.1007-9572.2023.0505.
[21]	MA W, YE G, LIU Y, et al. Impact of alcohol consumption on hyperuricemia and gout:a systematic review and meta-analysis[J]. Front Nutr, 2025,12:1588980. doi:10.3389/fnut.2025.1588980.
[22]	TE KARU L, DALBETH N, STAMP L K. Inequities in people with gout:a focus on Māori(Indigenous People)of Aotearoa New Zealand[J]. Ther Adv Musculoskelet Dis, 2021,13:1759720X211028007. doi:10.1177/1759720X211028007.
[23]	EUN Y, KIM I Y, HAN K, et al. Association between female reproductive factors and gout:a nationwide population-based cohort study of 1 million postmenopausal women[J]. Arthritis Res Ther, 2021, 23(1):304. doi:10.1186/s13075-021-02701-w.
[24]	PANG Y, YUAN Y, ZHOU W, et al. Trends and burden of gout among adolescents aged 10-24 years:insights from the global burden of disease study 2021[J]. Front Public Health, 2025,13:1526141. doi:10.3389/fpubh.2025.1526141.
[25]	CHENG Z, XU X, QI H, et al. Obesity reduces the urate-lowering efficacy among patients with primary gout: a prospective cohort study[J]. Rheumatology(Oxford), 2025, 64(6):3500-3508. doi:10.1093/rheumatology/keaf076.
[26]	GWINNUTT J M, WIECZOREK M, BALANESCU A, et al. 2021 EULAR recommendations regarding lifestyle behaviours and work participation to prevent progression of rheumatic and musculoskeletal diseases[J]. Ann Rheum Dis,2023, 82(1):48-56. doi:10.1136/annrheumdis-2021-222020.
[27]	WU Z, HU Y, HE H, et al. Association of walking volume and intensity with incident gout:a population-based cohort study[J]. Am J Epidemiol,2025:kwaf109. doi:10.1093/aje/kwaf109.
[28]	SELVADURAI D, COLESHILL M J, DAY R O, et al. Patient factors and health outcomes associated with illness perceptions in people with gout[J]. Rheumatology(Oxford), 2024, 63(7):1927-1937. doi:10.1093/rheumatology/kead501.
[29]	张汀, 贾化平, 王丁一, 等. 肌骨高频超声在痛风性关节炎临床诊疗中的应用进展[J]. 武警医学, 2025, 36(4):353-356.
	ZHANG T, JIA H P, WANG D Y, et al. Application progress of high-frequency musculoskeletal ultrasound in the clinical diagnosis and treatment of gouty arthritis[J]. Med J Chin PAP, 2025, 36(4):353-356. doi:10.14010/j.cnki.wjyx.2025.04.010.
[30]	DROSOS G C, VEDDER D, HOUBEN E, et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome[J]. Ann Rheum Dis, 2022, 81(6):768-779. doi:10.1136/annrheumdis-2021-221733.

时间	发病数	ASIR/（1/10万）	患病数
1990年
总人数	1 182 497.95	122.52	5 971 855.45
男性	899 778.75	183.71	4 534 505.34
女性	282 719.20	61.63	1 437 350.12
2021年
总人数	3 079 835.57	151.61	16 788 146.82
男性	2 301 318.17	230.89	12 484 533.51
女性	778 517.40	74.09	4 303 613.30
时间	ASPR/（1/10万）	DALYs	ASDR/（1/10万）
1990年
总人数	640.68	190 614.20	20.20
男性	963.57	145 586.69	30.48
女性	322.72	45 027.50	9.99
2021年
总人数	810.36	525 967.21	25.43
男性	1 232.34	393 758.52	38.83
女性	401.98	132 208.69	12.40

时间	发病数	ASIR/（1/10万）	患病数
1990年
总人数	1 182 497.95	122.52	5 971 855.45
男性	899 778.75	183.71	4 534 505.34
女性	282 719.20	61.63	1 437 350.12
2021年
总人数	3 079 835.57	151.61	16 788 146.82
男性	2 301 318.17	230.89	12 484 533.51
女性	778 517.40	74.09	4 303 613.30
时间	ASPR/（1/10万）	DALYs	ASDR/（1/10万）
1990年
总人数	640.68	190 614.20	20.20
男性	963.57	145 586.69	30.48
女性	322.72	45 027.50	9.99
2021年
总人数	810.36	525 967.21	25.43
男性	1 232.34	393 758.52	38.83
女性	401.98	132 208.69	12.40

分类	指标	趋势	年份	APC（95%CI）/%	AAPC（95%CI）/%
总人群	ASIR	1	1990—1994	-1.22（-1.52~-0.91）^＊	0.73（0.65~0.81）^＊
		2	1994—1999	0.18（-0.13~0.47）
		3	1999—2011	1.51（1.423~1.60）^＊
		4	2011—2021	0.94（0.83~1.05）^＊
	ASPR	1	1990—1994	-1.36（-1.62~-1.05）^＊	0.82（0.74~0.91）^＊
		2	1994—2000	0.29（0.07~0.51）^＊
		3	2000—2005	2.19（1.90~2.49）^＊
		4	2005—2021	1.18（1.13~1.23）^＊
	ASDR	1	1990—1994	-1.30（-1.63~-0.98）^＊	0.80（0.71~0.89）^＊
		2	1994—1999	0.22（-0.11~0.54）
		3	1999—2009	1.76（1.65~1.88）^＊
		4	2009—2021	1.06（0.97~1.15）^＊
男性	ASIR	1	1990—1994	-1.46（-1.74~-1.18）^＊	0.76（0.68~0.85）^＊
		2	1994—1999	0.51（0.23~0.80）^＊
		3	1999—2017	1.45（1.41~1.50）^＊
		4	2017—2021	0.42（0.02~0.82）^＊
	ASPR	1	1990—1994	-1.60（-1.91~-1.28）^＊	0.82（0.73~0.91）^＊
		2	1994—1999	0.57（0.25~0.90）^＊
		3	1999—2017	1.56（1.51~1.62）^＊
		4	2017—2021	0.45（-0.01~0.91）
	ASDR	1	1990—1994	-1.58（-1.90~-1.27）^＊	0.81（0.73~0.90）^＊
		2	1994—1999	0.58（0.26~0.90）^＊
		3	1999—2016	1.55（1.50~1.60）^＊
		4	2016—2021	0.51（0.19~0.84）^＊
女性	ASIR	1	1990—2000	-0.67（-0.78~-0.57）^＊	0.62（0.53~0.71）^＊
		2	2000—2009	2.39（2.25~2.53）^＊
		3	2009—2014	-0.47（-0.81~-0.13）^＊
		4	2014—2021	1.12（0.92~1.33）^＊
	ASPR	1	1990—2000	-0.74（-0.83~-0.64）^＊	0.74（0.66~0.82）^＊
		2	2000—2008	2.88（2.72~3.04）^＊
		3	2008—2014	-0.24（-0.48~0.01）
		4	2014—2021	1.34（1.15~1.54）^＊
	ASDR	1	1990—2000	-0.71（-0.81~-0.62）^＊	0.72（0.64~0.80）^＊
		2	2000—2008	2.83（2.67~2.99）^＊
		3	2008—2014	-0.17（-0.41~0.06）
		4	2014—2021	1.24（1.05~1.42）^＊

分类	指标	趋势	年份	APC（95%CI）/%	AAPC（95%CI）/%
总人群	ASIR	1	1990—1994	-1.22（-1.52~-0.91）^＊	0.73（0.65~0.81）^＊
		2	1994—1999	0.18（-0.13~0.47）
		3	1999—2011	1.51（1.423~1.60）^＊
		4	2011—2021	0.94（0.83~1.05）^＊
	ASPR	1	1990—1994	-1.36（-1.62~-1.05）^＊	0.82（0.74~0.91）^＊
		2	1994—2000	0.29（0.07~0.51）^＊
		3	2000—2005	2.19（1.90~2.49）^＊
		4	2005—2021	1.18（1.13~1.23）^＊
	ASDR	1	1990—1994	-1.30（-1.63~-0.98）^＊	0.80（0.71~0.89）^＊
		2	1994—1999	0.22（-0.11~0.54）
		3	1999—2009	1.76（1.65~1.88）^＊
		4	2009—2021	1.06（0.97~1.15）^＊
男性	ASIR	1	1990—1994	-1.46（-1.74~-1.18）^＊	0.76（0.68~0.85）^＊
		2	1994—1999	0.51（0.23~0.80）^＊
		3	1999—2017	1.45（1.41~1.50）^＊
		4	2017—2021	0.42（0.02~0.82）^＊
	ASPR	1	1990—1994	-1.60（-1.91~-1.28）^＊	0.82（0.73~0.91）^＊
		2	1994—1999	0.57（0.25~0.90）^＊
		3	1999—2017	1.56（1.51~1.62）^＊
		4	2017—2021	0.45（-0.01~0.91）
	ASDR	1	1990—1994	-1.58（-1.90~-1.27）^＊	0.81（0.73~0.90）^＊
		2	1994—1999	0.58（0.26~0.90）^＊
		3	1999—2016	1.55（1.50~1.60）^＊
		4	2016—2021	0.51（0.19~0.84）^＊
女性	ASIR	1	1990—2000	-0.67（-0.78~-0.57）^＊	0.62（0.53~0.71）^＊
		2	2000—2009	2.39（2.25~2.53）^＊
		3	2009—2014	-0.47（-0.81~-0.13）^＊
		4	2014—2021	1.12（0.92~1.33）^＊
	ASPR	1	1990—2000	-0.74（-0.83~-0.64）^＊	0.74（0.66~0.82）^＊
		2	2000—2008	2.88（2.72~3.04）^＊
		3	2008—2014	-0.24（-0.48~0.01）
		4	2014—2021	1.34（1.15~1.54）^＊
	ASDR	1	1990—2000	-0.71（-0.81~-0.62）^＊	0.72（0.64~0.80）^＊
		2	2000—2008	2.83（2.67~2.99）^＊
		3	2008—2014	-0.17（-0.41~0.06）
		4	2014—2021	1.24（1.05~1.42）^＊