Gout

What is gout?

Gout is a form of inflammatory arthritis. It occurs when excess uric acid in the blood leads to deposits of uric acid crystals in one or more joints. These deposits cause inflammation, with the big toe joint being most commonly affected. Gout can also affect other joints in the arms (fingers, wrists, elbows) and legs (toes, ankles, knees).

Signs and symptoms

Gout may be episodic (acute) or chronic. Acute gout is characterised by sudden attacks (flares) of severe pain, swelling, redness, heat, tenderness and stiffness in the affected joints.

These flares can last for days or weeks and are followed by long periods without any symptoms. If flares occur in the same joint over many years, and the underlying excess of uric acid is not controlled, gout can become chronic.

Risk factors

The underlying cause of gout is excess uric acid in the blood – a metabolic disorder called hyperuricaemia. This disorder is an independent risk factor for cardiovascular disease (Capuano et al. 2016) and metabolic syndrome (Grassi et al. 2014). Risk factors for hyperuricaemia include obesity, diabetes, hypertension and heart disease, poor kidney function and kidney disease, and a diet high in meat, seafood and alcohol (Capuano et al. 2016; Grassi et al. 2014).

Other factors that are associated with an increased risk of gout are family history, sex and age; gout is more common in men than in women and increases with age.

How common is gout?

Self-reported data from the Australian Bureau of Statistics 2017–18 National Health Survey shows that an estimated 0.8% of Australians have gout, which they described as 'current and long term'. Gout is more common in males than females – almost 9 in 10 (87%) people with gout are males (ABS 2019).

While the self-reported prevalence of gout may be low, Australian population-based studies show variation for different population groups. A study of a general practice population found the prevalence of gout to be 1.5%, with gout increasing with age to 11% in men and 4.6% in women aged 85 and over (Robinson et al. 2015).

Impact of gout

Gout can be very disabling due to significant pain and functional impairment. Frequent attacks of gout have been found to be associated with reduction in work participation (Chandratre et al. 2013; Lindsay et al. 2011).

Burden of disease

In 2022, gout accounted for 0.1% of total disease burden (DALY); 0.2% of non-fatal burden (YLD), and less than 0.1% of fatal burden (YLL). Within the musculoskeletal disease group, gout accounted for 0.7% of total burden (DALY).

Variation by age and sex

• Males had a higher rate of burden from gout than females, after adjusting for age (0.3 and 0.03 DALY per 1,000 population, respectively).
• The rate of burden from gout increased with age and peaks at age 95–99 for males (1.9 DALY per 1,000 population and for females aged 80–84 and 95–99 (0.3 DALY per 1,000 population, each).

Figure 1: Burden of disease due to gout by age, sex and year

Trends over time

The rate of gout burden has halved from 0.4 to 0.2 DALY per 1,000 population between 2003 to 2022, after adjusting for age.

Further detail is available in the Australian Burden of Disease Study 2022.

Variation between population groups

In 2018, after adjusting for age:

• The rate of burden from gout is twice as high in Remote and very remote areas compared with Major cities, after adjusting for differences in age structure (0.4 and 0.2 DALY per 1,000 population, respectively).
• The rate of burden from gout ranged between 0.1 and 0.2 DALY per 1,000 population across socioeconomic groups (AIHW 2021).

Further detail is available in the Australian Burden of Disease Study 2018: Interactive data on disease burden.

Figure 2: Burden of disease due to gout by remoteness area and socioeconomic group, sex and year

Health system expenditure

In 2019–20, an estimated $233.7 million of expenditure in the Australian health system was for gout, representing 0.2% of total health expenditure and 1.6% of expenditure for all musculoskeletal conditions (AIHW 2022b).

Where is the money spent?

Figure 3 presents a detailed breakdown of estimated expenditure for gout by area of the health system, showing that:

• Hospital services represented 55% ($129.3 million) of gout expenditure, which was lower than the proportion of total health expenditure for hospital services (63%). The public hospital outpatient service proportion of gout expenditure was higher in comparison to the average, almost 3 times the proportion for total health expenditure (13% compared with 4.7%).
• Primary Health Care accounted for 35% ($81.4 million) of gout expenditure, which was more than the primary health care portion of total health expenditure (28%). The general practitioner services proportion of gout expenditure was relatively high, at more than double that for total health expenditure (17% compared with 7.8%).
• Referred medical services represented 9.9% ($23.1 million) of gout health expenditure, which was similar to the proportion of total health expenditure for referred medical services (9.1%). However, the pathology portion of gout expenditure was relatively high, at over 3 times the proportion for total health expenditure (6.2 compared with 2.0%).

Figure 3: Amount and proportion (%) of gout expenditure attributed to each area of the health system, compared to expenditure for all disease groups, 2019–20

Figure 4 presents each area of health system expenditure and the proportion (%) that is spent on gout, showing that in 2019–20, gout accounted for:

• 0.5% ($14.4 million) of all pathology expenditure
• 0.4% ($40.1 million) of all general practitioner service expenditure.

Figure 4: Proportion of expenditure attributed to gout, for each area of the health system, 2019–20

Who is the money spent on?

The distribution of health system expenditure on gout across age groups and sex reflects the prevalence distribution of the condition.

In 2019–20:

• most heath system expenditure is for older age groups (76% for people aged 55 and over).
• health system expenditure for gout was 4.5 times as high among males compared with females ($189.5 million and $42.5 million).

Further detail is available in Disease expenditure in Australia 2019–20.

In 2018–19, it was estimated that:

• gout expenditure per case was 1.5 times greater for females than males ($1,500 and $1,000 per case, respectively)
• gout expenditure per case was 11% lower than musculoskeletal conditions as a group ($1,100 and $1,200 per case, respectively) (AIHW 2022c).

Further detail is available in Health system spending per case of disease and for certain risk factors: data tables.

Deaths

How many deaths were associated with gout?

Gout was recorded as an underlying or associated cause for 462 deaths or 1.3 deaths per 100,000 population in Australia in 2021, representing 0.3% of all deaths and 5.0% of all musculoskeletal deaths. Gout was the underlying cause for 22 deaths (4.8% of gout deaths) and an associated cause only, for 440 deaths (95% of gout deaths).

Variation by age and sex

In 2021, gout mortality (as the underlying and/or associated cause) was concentrated amongst:

• older people (77% aged 75 and over), which was more than the proportion of people aged 75 and over for total deaths (67%)
• males (73% of gout deaths were male compared with 52% of total deaths).

Further detail on mortality data is available in the Chronic musculoskeletal condition mortality data tables 2023.

Figure 5: Age profile of gout mortality statistics, by sex

Figure 6: Historical gout mortality statistics, by sex, 2011–2021

Treatment and management of gout

Gout can be managed or even prevented by long-term therapy with medications and lifestyle changes to control hyperuricaemia and reduce levels of uric acid in the body.

Gout can be controlled with early and ongoing treatment, including:

• establishing a definitive diagnosis
• providing rapid pain relief for flares
• preventing flares and complications (Graf et al. 2015; Khanna et al. 2012; Richette et al. 2016).

Flares and complications can be managed by reducing risk factors for hyperuricaemia (dehydration, obesity and alcohol intake), taking urate-lowering medications to keep uric acid levels low, and managing comorbid conditions, such as high blood pressure, chronic kidney disease, diabetes and heart disease (Khanna et al. 2012).

The use of non-steroidal anti-inflammatory drugs (NSAIDs), low-dose colchicine and oral/intra-muscular/intra-articular glucocorticoids has also been found to be effective in managing acute gout (Graf et al. 2015; Richette et al. 2016).

Data from the AIHW National Hospital Morbidity Database (NHMD) show that, in 2020–21:

• 8,100 hospitalisations had a principal diagnosis of gout (32 per 100,000 population)
• 80% of all hospitalisations for gout were for males (6,500 hospitalisations), compared with 20% for females (1,600 hospitalisations)
• the hospitalisation rates increased with age and were highest for people aged 85 and over (245 per 100,000 population) (Figure 7)
• the average length of overnight stays also increased with age and was longest for people aged 85 and over at 6.7 days (Figure 7).

Figure 7: Age profile of gout hospitalisation statistics, by sex

The hospitalisation rate for Australians with a principal diagnosis of gout increased between 2010–11 and 2020–21 from 22 hospitalisations per 100,000 population to 32 per 100,000 population. There was a slightly larger increase for males (43%, from 36 to 51 per 100,000 population) compared with females (35%, from 9.2 to 12 per 100,000 population) (Figure 8).

The hospitalisation rate for gout among males dropped markedly in 2019–20. This may have been due to widespread public health mandates because of the COVID-19 pandemic. In 2020–21, the hospitalisation rate returned to near or slightly above the pre-pandemic rate. Interestingly, the hospitalisation rate among women had been on a gentle decline since 2016–17 and this trend was not noticeably impacted in 2019–20.

Approximately three-quarters of all hospitalisations with a principal diagnosis of gout are overnight stays. The average length of stay for these hospitalisations has trended downwards from 5.9 in 2010–11 to 4.9 in 2020–21.

Figure 8: Historical gout hospitalisation statistics, by sex, 2010–11 to 2020–21