Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study

Chang-Fu Kuo, Matthew J Grainge, Christian Mallen, Weiya Zhang, Michael Doherty, Chang-Fu Kuo, Matthew J Grainge, Christian Mallen, Weiya Zhang, Michael Doherty

Abstract

Objectives: To describe trends in the epidemiology of gout and patterns of urate-lowering treatment (ULT) in the UK general population from 1997 to 2012.

Methods: We used the Clinical Practice Research Datalink to estimate the prevalence and incidence of gout for each calendar year from 1997 to 2012. We also investigated the pattern of gout management for both prevalent and incident gout patients.

Results: In 2012, the prevalence of gout was 2.49% (95% CI 2.48% to 2.51%) and the incidence was 1.77 (95% CI 1.73 to 1.81) per 1000 person-years. Prevalence and incidence both were significantly higher in 2012 than in 1997, with a 63.9% increase in prevalence and 29.6% increase in incidence over this period. Regions with highest prevalence and incidence were the North East and Wales. Among prevalent gout patients in 2012, only 48.48% (95% CI 48.08% to 48.89%) were being consulted specifically for gout or treated with ULT and of these 37.63% (95% CI 37.28% to 38.99%) received ULT. In addition, only 18.6% (95% CI 17.6% to 19.6%) of incident gout patients received ULT within 6 months and 27.3% (95% CI 26.1% to 28.5%) within 12 months of diagnosis. The management of prevalent and incident gout patients remained essentially the same during the study period, although the percentage of adherent patients improved from 28.28% (95% CI 27.33% to 29.26%) in 1997 to 39.66% (95% CI 39.11% to 40.22%) in 2012.

Conclusions: In recent years, both the prevalence and incidence of gout have increased significantly in the UK. Suboptimal use of ULT has not changed between 1997 and 2012. Patient adherence has improved during the study period, but it remains poor.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Age-specific prevalence (A) and incidence (B) of gout in 2012 (Blue: men; red: women; green: total; dotted lines show 95% confidence bounds).
Figure 2
Figure 2
Gender differences in the trends of standardised prevalence (A) and incidence (B) of gout between 1997 and 2012 (blue: men; red: women; green: overall; dotted line: 95% confidence bounds).
Figure 3
Figure 3
Geographic variations in the prevalence (A) and incidence (B) of gout in the UK in 2012.
Figure 4
Figure 4
Management of gout (A) standardised percentage of prevalent patients being consulted for gout or treated with ULT (blue line), and treated with urate-lowering agents (red line) and (B) standardised percentage of incident patients receiving urate-lowering treatment at 6 months (red line) and 12 months (blue line).
Figure 5
Figure 5
Secular trends of adherence of urate-lowering treatment (ULT) treated patients (blue: adherent; red: partially adherent; green: non-adherent patients).

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Source: PubMed

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