Gout
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Gout is a form of inflammatory arthritis which occurs when excess uric acid in the blood leads to deposits of uric acid crystals in one or more joints causing inflammation. The big toe joint is most commonly affected.
An estimated 190,000 (0.8%) people in Australia reported having gout in 2017–18.
- Gout accounted for 0.7% of the total disease burden due to musculoskeletal conditions in 2023.
- In 2020–21, an estimated $230.8 million was spent on the treatment and management of gout, representing 0.2% of total health system expenditure and 1.6% of expenditure for all musculoskeletal conditions.
- Gout contributed to 462 deaths or 1.3 deaths per 100,000 population in 2021, representing 0.3% of all deaths.
Treatment and management of gout
In 2021–22, there were 7,100 hospitalisations with a principal diagnosis of gout (27 per 100,000 population).
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).
Gout can 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 associated with gout
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. 2017) 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. 2017; Grassi et al. 2014).
How common is gout?
An estimated 190,000 (0.8%) people in Australia reported having gout, based on the Australian Bureau of Statistics 2017–18 National Health Survey.
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).
Gout was more common in males than females – 87% of people with gout were males in 2017–18 (ABS 2019).
Impact of gout
Gout can have a significant impact on people’s lives including intense joint pain and swelling as well as 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
What is burden of disease?
Burden of disease is measured using the summary metric of disability-adjusted life years (DALY, also known as the total burden). One DALY is one year of healthy life lost to disease and injury. DALY caused by living in poor health (non-fatal burden) are the ‘years lived with disability’ (YLD). DALY caused by premature death (fatal burden) are the ‘years of life lost’ (YLL) and are measured against an ideal life expectancy. DALY allows the impact of premature deaths and living with health impacts from disease or injury to be compared and reported in a consistent manner (AIHW 2022a).
In 2023, gout accounted for 0.1% of total disease burden (DALY), 0.2% of non-fatal burden (YLD), and less than 0.01% of fatal burden (YLL). Within the musculoskeletal disease group, gout accounted for 0.7% of total burden (DALY) (AIHW 2023a).
Between 2003 and 2023, the rate of gout burden halved from 0.35 to 0.17 DALY per 1,000 population, after adjusting for age (Figure 1). For more information, see Australian Burden of Disease Study 2023 and the Australian Burden of Disease Study 2018: Interactive data on disease burden.
Figure 1: Burden of disease due to gout by age, sex and year
This figure shows that the burden of gout was greater in males compared with females.
Health system expenditure
In 2020–21, an estimated $230.8 million of expenditure in the Australian health system was for gout, representing 0.2% of total health system expenditure and 1.6% of expenditure for all musculoskeletal conditions (AIHW 2023b).
The distribution of health system expenditure on gout by age and sex reflects the prevalence distribution, with spending concentrated amongst older age groups and males.
For more information, see Disease expenditure in Australia 2020–21 (AIHW 2023b) and Health system spending per case of disease and for certain risk factors: data tables (AIHW 2022b).
How many deaths were associated with gout?
Gout was recorded as an underlying and/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).
Gout mortality rates (underlying and/or associated cause) changed little between 2011 and 2021 (2.5 and 2.2 per 100,000 population, respectively).
For more information on mortality data, see the Chronic musculoskeletal condition mortality data tables 2023.
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).
Hospitalisations for gout
People with gout may require admission to hospital when they experience 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.
Data from the National Hospital Morbidity Database (NHMD) show that in 2021–22, there were 21,700 hospitalisations with a principal or additional diagnosis (any diagnosis) of gout, representing 0.2% of all hospitalisations.
The rest of this section discusses hospitalisations with a principal diagnosis of gout, unless otherwise stated. However, charts and tables also include statistics for any diagnosis of gout.
In 2021–22:
- there were 7,100 hospitalisations, representing 0.1% of all hospitalisations in Australia, and 27 hospitalisations per 100,000 population
- gout accounted for 29,500 bed days, representing 0.1% of all bed days
- 77% of gout hospitalisations were overnight stays, with an average length of 5.1 days (Figure 2).
Variation by age and sex
In 2021–22, gout hospitalisation rates:
- increased with age and were highest for people aged 85 and over (210 per 100,000 population)
- were 3.7 times as high for males compared with females (43 and 12 per 100,000 population, respectively) (Figure 2).
Trends over time
From 2011–12 to 2021–22, for gout hospitalisations the rate changed little over time (25 to 27 per 100,000 population).
Figure 2: Age distribution for gout hospitalisations, by sex, 2021–22
This figure shows the average length of overnight hospitalisations for people aged 85 and over with a principal diagnosis of gout was almost 7 days.
ABS (Australian Bureau of Statistics) (2019) Microdata: National Health Survey, 2017–18, AIHW analysis of detailed microdata, accessed 28 April 2023.
AIHW (Australian Institute of Health and Welfare) (2021) Australian Burden of Disease Study 2018: Interactive data on disease burden, AIHW, Australian Government, accessed 22 May 2023.
AIHW (2022a) Australian Burden of Disease Study 2022, AIHW, Australian Government, accessed 19 May 2023. doi:10.25816/e2v0-gp02.
AIHW (2022b) Health system spending per case of disease and for certain risk factors, AIHW, Australian Government, accessed 19 May 2023.
AIHW (2023a) Australian Burden of Disease Study 2023, AIHW, Australian Government, accessed 14 December 2023.
AIHW (2023b) Disease expenditure in Australia 2020–21, AIHW, Australian Government, accessed 14 December 2023.
Capuano V, Marchese F, Capuano R, Torre S, Iannone A, Capuano E, Lamaida N, Sonderegger M and Capuano E (2017) ‘Hyperuricaemia as an independent risk factor for major cardiovascular events: a 10-year cohort study from Southern Italy’, Journal of Cardiovascular Medicine, 18(3):159-164, doi:10.2459/JCM.0000000000000347.
Chandratre P, Roddy E, Clarson L, Richardson J, Hider SL and Mallen CD (2013) ‘Health-related quality of life in gout: a systematic review’, Rheumatology Oxford, 52(11):2031–2040, doi:10.1093/rheumatology/ket265.
Graf SW, Whittle SL, Wechalekar MD, Moi JHY, Barrett C, Hill CL, Littlejohn G, Lynch N, Gabor M, Taylor AL, Buchbinder R and Zochling J (2015) ‘Australian and New Zealand recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion in the 3e Initiative’, International Journal of Rheumatic Diseases, 18:341–351, doi:10.1111/1756-185X.12557.
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Lindsay K, Gow P, Vanderpyl J, Logo P and Dalbeth N (2011) ‘The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach’, Journal of Clinical Rheumatology, 17(1):1–6, doi:10.1097/RHU.0b013e318204a8f9.
Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castaneda-Sanabria J, Coyfish M, Guillo S, Jansen T, Janssens H, Liote F, Mallen C, Nuki G, Perez-Ruiz F, Pimentao J, Punzi L, Pywell T, So A, Tausche A, Uhligh T, Zavada J, Zhang W, Tubach F and Bardin T (2016) ‘2016 updated EULAR evidence-based recommendation for the management of gout’, Annals of the Rheumatic Diseases, 76(1):29-42, doi:10.1136/annrheumdis-2016-209707.
Robinson PC, Taylor WJ and Dalbeth N (2015) ‘An observational study of gout prevalence and quality of care in a national Australian general practice population’, The Journal of Rheumatology, 42(9):1702–1707, doi: https://doi.org/10.3899/jrheum.150310.