Global, Regional, and National Burden of Gout, 1990–2020, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021

Background: Gout is an inflammatory arthritis manifesting as acute episodes of severe joint pain and swelling which can progress to chronic destructive arthritis. We present the most up-to-date global, regional, and national estimates for prevalence and years lived with disability (YLDs) due to gout by sex, age, and country from the Global Burden of Diseases, Injuries, and Risk Factors 2021 Study, and projections to 2050 by region.Methods: Gout prevalence and YLDs were estimated using nested Bayesian meta-regression models, drawing on data from 35 countries. Estimates were generated by age, sex, country, and year, and leveraged geographical proximity and predictive covariates to model predictions for data-sparse locations. The number of cases of gout was estimated up to 2050, using forecasted population estimates and a logistic regression with forecasted population estimates and Socio-demographic Index to forecast prevalence.Findings: In 2020, 55.8 million (95% uncertainty interval 44.4–69.8) prevalent cases of gout were estimated, with an age-standardised prevalence of 659.3 per 100,000 (525.4–822.3), an increase of 22.5% (20.9–24.2) since 1990. Globally, the prevalence of gout in 2020 was 3.26 times (3.11–3.39) higher in males than females and increased with age. The total number of prevalent cases of gout is projected to reach 95.8 million (81.1–116) cases in 2050, with population growth being the largest contributor to this increase. The global age-standardised YLD rate of gout was 20.5 per 100,000 (14.4–28.2) population in 2020. High BMI and kidney dysfunction accounted for 34.3% (27.7–40.6) and 11.8% (9.3–14.2) of the YLDs due to gout, respectively.Interpretation: The number of individuals with gout will almost double by 2050, primarily due to population growth and ageing. As around one-third of gout disability is a result of high BMI, dietary and lifestyle modifications with a focus on weight reduction are needed at the population level to reduce the burden of gout. Despite the rigour of the standardised GBD methodology and modelling, in many countries, particularly low-middle-income countries, estimates are based on modelled rather than primary data and are lacking severity and disability estimates. We strongly encourage the collection of these data to be included in future GBD iterations.Funding: Bill and Melinda Gates Foundation, Global Alliance for Musculoskeletal Health (G-MUSC).Declaration of Interest: MC declares no COI, GTC declares no COI, JDS declares no COI, JK declares no COI, LMH declares no COI, PMB declares no COI, PAR declared no COI, HH declares no COI, KLO declares no COI, DKG declares no COI, KD declares no COI, Neil Betteridge has received consultancy fees from Galapagos, Grunenthal, Lilly and Sanofi, TV declares no COI, LM declares no COI, ADW declares no COI.