Gout currently affects a greater proportion of Asians in the United States than any other racial or ethnic group, a new study finds.

Investigators studied a nationally representative sample of 22,621 US adults from the 2011-2018 National Health and Nutrition Examination Survey (NHANES). The age- and sex-adjusted gout prevalence among Asians doubled from 3.3% in 2011 to 6.6% in 2017-2018, Chio Yokose, MD, MSc, of Massachusetts General Hospital in Boston, and colleagues reported in JAMA Network Open.1 In comparison, 5.7%, 4.9%, and 3.9% Black, White, and Hispanic adults had gout in 2017-2018. Asian adults had 61% increased odds of developing gout compared with White adults.

The excess burden of gout among Asians was especially large among Medicare beneficiaries (aged 65 years or older), affecting 14.8% of Asian vs 10.0% of White individuals in 2017-2018. Gout prevalence was especially high (23.6%) among older Asian men.

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“These findings are consistent with those from prior ecological data showing higher concentrations of serum urate and adiposity and poorer quality diet among Asian individuals living in the US than those living in East Asian countries,” the investigators wrote.

From 2011 to 2018, Asians in the United States had larger increases in body mass index (BMI), waist circumference, and body fat percentage, compared with other racial and ethnic groups. Serum urate levels significantly increased over time along with BMI. Insurance coverage also increased, indicating greater health care access. BMI and socioclinical factors, however, did not fully explain the excess gout burden. After BMI and insurance were both adjusted, the odds of gout were still increased 1.3-fold. In a fully adjusted model, Asian adults had 0.50 mg/dL higher urate levels and 2.6-fold increased odds for gout compared with White adults.

The investigators used data from the 2006-2021 UK Biobank to corroborate the findings. Asian adults in the United Kingdom sample had 0.30 mg/dL higher urate levels and 1.6-fold increased odds for gout compared with White adults.

“These findings suggest that, unlike serum urate trends, there are other factors contributing to the gout prevalence trend that were not included in our models,” according to Dr Yokose’s team.

A 2021 study published in Healthcare,2 for example, found that Asian adults have greater risks for metabolic syndrome than White adults with the same BMI. A 2022 study in BMC Nephrology found that Asians have urate risk allele variants.3 Gene-environmental interactions may play a role in susceptibility, according to the investigators.

Allopurinol for urate-lowering therapy is underprescribed among Asians. The 2020 American College of Rheumatology gout guideline recommends testing for the HLA–B*5801 allele prior to starting allopurinol in patients of Southeast Asian descent (eg, Han Chinese, Korean, Thai), as well as African American patients, due to the risk for allopurinol hypersensitivity syndrome.4

Among the study’s limitations, the investigators noted that the Asian category comprised more than 40 ethnic subgroups. Further granular research is needed.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References

  1. Yokose C, McCormick N, Lu N, et al. Trends in prevalence of gout among US Asian adults, 2011-2018. JAMA Netw Open. Published online April 3, 2023. doi:10.1001/jamanetworkopen.2023.9501
  2. Zhu L, Yang WJ, Spence CB, Bhimla A, Ma GX. Lean yet unhealthy: Asian American adults had higher risks for metabolic syndrome than non-Hispanic White Adults with the same body mass index—evidence from NHANES 2011-2016. Healthcare. 2021;9(11):1518. doi:10.3390/healthcare9111518
  3. Alghubayshi A, Edelman A, Alrajeh K, Roman Y. Genetic assessment of hyperuricemia and gout in Asian, Native Hawaiian, and Pacific Islander subgroups of pregnant women: biospecimens repository cross-sectional study. BMC Rheumatol. 2022;6(1):1. doi:10.1186/s41927-021-00239-7
  4. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology guideline for the management of gout. Arthritis Care Res. 2020;72(6):744-760. doi:10.1002/acr.24180

Topics:

Gout Health Disparity Hyperuricemia Race Differences