Im Pek Kei, Kartsonaki Christiana, Kakkoura Maria G, Mohamed-Ahmed Olaa, Yang Ling, Chen Yiping, Du Huaidong, Yang Xiaoming, Zhang Hua, Sun Dianjianyi, Yu Canqing, Lv Jun, Li Liming, Chen Zhengming, Millwood Iona Y
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
NCDs Prevention and Control Department, Qingdao CDC, Qingdao, Shandong, China.
Lancet Reg Health West Pac. 2025 May 14;58:101572. doi: 10.1016/j.lanwpc.2025.101572. eCollection 2025 May.
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.
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.
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.
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.
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.
尽管高尿酸血症和痛风的患病率不断上升，但在包括中国在内的许多人群中，它们的流行病学及相关合并症负担仍未得到充分研究。我们旨在研究中国成年人血浆尿酸水平模式、高尿酸血症患病率和痛风发病率，并调查痛风与一系列合并症及全因死亡率之间的关联。
前瞻性的中国嘉道理生物银行在2004年至2008年期间从十个不同地区招募了512,724名30至79岁的成年人，并对16,817名参与者测量了血浆尿酸水平。通过与登记处和医院记录的电子链接监测痛风和其他疾病的发病率及死亡情况。Cox回归和逻辑回归得出了与痛风、高尿酸血症和尿酸水平相关的死亡率和合并症风险的调整后风险比（HR）和比值比（OR）。
痛风发病率为每10万人年23.4例，男性和年龄较大的参与者发病率更高，且地区差异很大。痛风与全因死亡率（HR = 1.58，95%置信区间1.37 - 1.82）、心血管疾病（1.87，1.64 - 2.14）、慢性肾脏病（5.61，4.45 - 7.07）、尿路结石（2.50，1.85 - 3.38）、糖尿病（1.99，1.51 - 2.62）、食管、胃和十二指肠疾病（第二部分：2.14，1.72 - 2.66）、传染病和寄生虫病（1.91，1.47 - 2.48）、关节病（6.06，4.98 - 7.38）以及其他肌肉骨骼疾病（2.10，1.77 - 2.51）的较高风险相关。这些关联大多是双向的，随时间持续存在，并且在调整心血管代谢危险因素后影响不大。此外，患痛风的参与者更有可能患有多种重大疾病且住院次数更多。在测量血浆尿酸的亚组中，15%患有高尿酸血症，在男性、老年女性和城市居民中更为常见，并且与痛风、全因死亡率以及几种心血管代谢、肾脏、消化和肌肉骨骼疾病的风险增加相关。
在中国成年人中，痛风与多种合并症及不良健康轨迹相关。我们的研究结果强化了对痛风及相关合并症进行预防和管理的必要性。
嘉道理慈善基金会、中国国家自然科学基金、慢性非传染性疾病 - 国家科技重大专项、英国心脏基金会、英国癌症研究中心、惠康信托基金会、英国医学研究理事会、牛津大学纳菲尔德人口健康系。
