Hyperuricemia, gout and the associated comorbidities in China: findings from a prospective study of 0.5 million adults
Pek Kei Im, Christiana Kartsonaki, Maria Kakkoura, Olaa Mohamed-Ahmed, Ling Yang, Yiping Chen, Huaidong Du, Xiaoming Yang, Hua Zhang, Dianjianyi Sun, Canqing Yu, Jun Lv, Liming Li, Zhengming Chen, Iona Y. Millwood, Iona Y. Millwood, Iona Y. Millwood, Junshi Chen, Zhengming Chen, Robert Clarke, Rory Collins, Liming Li, Jun Lv, Richard Peto, Robin Walters, Daniel Avery, Maxim Barnard, Derrick Bennett, Ruth Boxall, Ka Hung Chan, Yiping Chen, Zhengming Chen, Charlotte Clarke, Jonathan Clarke, Robert Clarke, Huaidong Du, Ahmed Edris Mohamed, Hannah Fry, Simon Gilbert, Pek Kei Im, Pek Kei Im, Andri Iona, Maria Kakkoura, Christiana Kartsonaki, Kshitij Kolhe, Hubert Lam, Kuang Lin, James Liu, Mohsen Mazidi, Iona Millwood, Iona Millwood, Sam Morris, Qunhua Nie, Alfred Pozarickij, Maryam Rahmati, Paul Ryder, Dan Schmidt, Becky Stevens, Iain Turnbull, Robin Walters, Baihan Wang, Lin Wang, Neil Wright, Ling Yang, Xiaoming Yang, Pang Yao, Xiao Han, Can Hou, Qingmei Xia, Chao Liu, Jun Lv, Pei Pei, Dianjianyi Sun, Canqing Yu, Lang Pan, Zengchang Pang, Ruqin Gao, Shanpeng Li, Haiping Duan, Shaojie Wang, Yongmei Liu, Ranran Du, Liang Cheng, Xiaocao Tian, Hua Zhang, Dan Hu, Xiaoyan Zheng, Yujie Wang, Wei Sun, Shichun Yan, Xiaoming Cui, Chi Wang, Zhenyuan Wu, Lishun Zhai, Zhaoxi Pang, Shiwen Dong, Huiming Luo, Jinyan Chen, Bin He, Dingwei Sun
Abstract
Background: Despite the growing prevalence of hyperuricemia and gout, their epidemiology and associated comorbidity burden remains poorly studied in many populations, including China. We aimed to examine the patterns of plasma urate level, prevalence of hyperuricemia, and incidence of gout, and investigate the associations of gout with a range of comorbidities and all-cause mortality in Chinese adults. Methods: The prospective China Kadoorie Biobank recruited 512,724 adults aged 30-79 years from ten diverse areas in 2004-2008 and measured plasma urate level among 16,817 participants. The incidence of gout and other diseases and deaths were monitored by electronic linkages with registries and hospital records. Cox and logistic regression yielded adjusted HRs and ORs for risks of mortality and comorbidities associated with gout, hyperuricemia, and urate level. Findings: The gout incidence rate was 23.4 per 100,000 person-years, and was higher in men and older participants, and varied substantially by region. Gout was associated with higher risks of all-cause mortality (HR = 1.58, 95% CI 1.37-1.82), CVD (1.87, 1.64-2.14), CKD (5.61, 4.45-7.07), urolithiasis (2.50, 1.85-3.38), diabetes (1.99, 1.51-2.62), diseases of the oesophagus, stomach, and duodenum (2.14, 1.72-2.66), infectious and parasitic diseases (1.91, 1.47-2.48), arthropathies (6.06, 4.98-7.38), and other musculoskeletal disorders (2.10, 1.77-2.51). Most of these associations were bi-directional, sustained over time and little affected by adjustment for cardiometabolic risk factors. Moreover, participants who developed gout were more likely to have multiple major diseases and more hospitalisations. Among the subset with plasma urate measured, 15% had hyperuricemia, which was more common in men, older women, and urban residents, and was associated with increased risks of gout, all-cause mortality, and several cardiometabolic, renal, digestive, and musculoskeletal diseases. Interpretation: In Chinese adults, gout was associated with several comorbidities and a poor health trajectory. Our findings reinforce the need for prevention and management of gout and associated comorbidities. Funding: Kadoorie Charitable Foundation, National Natural Science Foundation of China, Noncommunicable Chronic Diseases-National Science and Technology Major Project, British Heart Foundation, Cancer Research UK, Wellcome Trust, UK Medical Research Council, Nuffield Department of Population Health at the University of Oxford.