Modifiable risk factors and incidence of gout: Estimation of population attributable fraction in the US

The burden of gout is substantial in the United States (US). Most gout cases can be attributed to modifiable risk factors, while systematic evidence-based assessment of gout cases and incidence attributable to the risk factors in the US is limited.The estimated cases and incidence of gout in the US was obtained from global burden of disease (GBD) study 2019. We calculated the exposure rate of risk factors from National Health and Nutrition Examination Survey (NHANES) 2009-2010, since we estimated an average induction time of 10 years for risk factors and gout. We also conducted a meta-analysis to evaluate the associations of modifiable risk factors and gout in the US population. Furthermore, the population attributable fraction (PAF) was calculated using based on the prevalence of risk factors and relative risk (RR) from the meta-analysis.The weighted prevalence of hypertension was 14.37%, and the average body mass index (BMI) and alcohol consumption was 28.50 kg/m2 and 7.14 g/d, respectively. Meta-analysis showed that individuals with hypertension had a higher risk of gout (2.12, 95% CI 1.88 to 2.40). For every five units of increase in BMI, the risk of gout increased by 1.48-fold (95% CI 1.26 to 1.75). The pooled RR was 1.21 (95% CI 1.13 to 1.29) for every 10 g/day increment of alcohol consumption. BMI, hypertension and alcohol consumption accounted for 53.58%, 13.85% and 12.66% of gout cases, respectively. Overall, 65.05% of gout incidence was attributable to the joint effects of these three risk factors.Hypertension, excess BMI and high alcohol consumption were responsible for approximately 65% of gout incidence in the US in 2019. Reducing the exposure to these factors can effectively reduce the incidence of gout.