Gout - Risk Factors

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Introduction	Risk Factors	Lifestyle Changes
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Risk Factors

Risk factors are attributes or activities associated with a greater-than-normal likelihood of developing a particular disorder. Sometimes a causal connection between the attribute or activity and the disorder can be established, but at other times there is simply a statistical correlation. The risk factors for gout, of which there are several, are identical to those for hyperuricemia.

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Prevalence

Gout is the second most common inflammatory arthritic condition in older adults. Based on self-reports, gout is estimated to affect about 2.1 million Americans (1.56 million men and 550,000 women). Some experts believe, however, that this may be an overestimate. The prevalence of gout has been rising in recent decades, not only in America but in other developed countries, possibly because of dietary and lifestyle changes, greater use of medications that cause hyperuricemia, and aging populations.

Gout is very uncommon in less-developed countries, however, and in 1952 it was said to be unknown in China, Japan, and the tropics.

Age

Middle-Aged Adults. Gout usually occurs in middle-aged men, peaking in the mid-40s. It is most often associated in this age group with obesity, high blood pressure, unhealthy cholesterol levels, and heavy alcohol use.

Elderly. Gout can also first develop in older people, when it occurs equally in men and women. In this group, gout is most often associated with kidney problems and the use of diuretics. It is less often associated with alcohol use.

Children. Among children, the levels of uric acid in both girls and boys are low, averaging 3 to 4 mg/dL. Except for rare inherited genetic disorders that cause hyperuricemia, gout in children is almost unheard of.

Gender

Men. Men are significantly at higher risk for gout. In males, uric acid levels rise substantially at puberty, with the result that the level exceeds 7 mg/dL (considered to indicate hyperuricemia) in about 5 -8% of American men. Gout typically strikes only after 20 to 40 years of persistent hyperuricemia, however, so men who develop it usually experience their first attack between the ages of 30 and 50 years. In one study that followed male medical students for 28 years, the prevalence of gout was 5.8% in Caucasian men and 10.9% in African American men.

Women. Before menopause, women have a significantly lower risk for gout than men, possibly because of the actions of estrogen. This female hormone appears to facilitate uric acid excretion by the kidneys. (Only about 15% of female gout cases occur before menopause.) After menopause the risk increases in women so that after age 60 the incidence is equal in men and women, and after 80, gout occurs actually more often in women.