Epidemiology and management of gout in Taiwan: a nationwide population study

Abstract

IntroductionGout is the most common inflammatory arthritis worldwide and is the only type of chronic arthritis that potentially can be ‘cured’. However, data on gout incidence, prevalence and management, assessed at multiple time points in the same population, are sparse, particularly in Asian populations. The aim of this study was to describe trends in the epidemiology of gout in the general population of Taiwan.MethodsThe National Health Insurance Research Database was used to identify patients with gout and to estimate the prevalence and incidence of gout for each calendar year from 2005 to 2010. The pattern of gout management was also examined.ResultsOf 23,371,362 beneficiaries in 2010, there were 1,458,569 prevalent and 56,595 incident cases of gout, giving a prevalence of 6.24% (95% confidence interval (CI), 6.23% to 6.25%) and an incidence of 2.74 (95% CI, 2.72 to 2.76) per 1,000 person-years. The annual percentage change (APC) of the standardised prevalence was −0.7% (95% CI, −1.7% to 0.3%; P = 0.14), suggesting that the prevalence of gout was essentially the same throughout the study period. However, The APC of incidence was −13.4 (95% CI, −16.1 to −10.6) between 2005 and 2007 and −2.1 (95% CI, −10.4 to 7.1) between 2007 and 2010. Regions with the highest prevalence and incidence were eastern coastal counties and offshore islets, where indigenous people are clustered. Among prevalent gout cases in 2010, only 22.93% (95% CI, 22.87% to 23.00%) were prescribed urate-lowering treatment (ULT), which remained unchanged between 2005 and 2010 at an APC of 0.0 (95% CI, −3.8 to 4.0). Uricosuric agents were more commonly prescribed than xanthine oxidase inhibitors in Taiwan.ConclusionsIn Taiwan, 1 in 16 people have gout. Whereas the incidence has decreased recently, the prevalence remains unchanged. Management of gout in Taiwan is poor, with only one in five affected people being treated with ULT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0522-8) contains supplementary material, which is available to authorized users.

The rising prevalence and incidence of gout in British Columbia, Canada: Population-based trends from 2000 to 2012

“…For instance, two recent studies from the UK and Taiwan also found unchanging trends in ULT treatment among prevalent gout patients, with approximately 25-35% of patients receiving ULT over the study period [9, 17]. In an earlier UK-based study (i.e., 1990-1999), Mikuls et al also reported a stable proportion of allopurinol use, ranging from 25-30% [20].…”

“…To facilitate comparisons with prior studies of gout prevalence and incidence in other countries [9, 17-21], our primary case definition of gout required at least one recorded principal diagnosis of gout (ICD-9-CM 274 or ICD-10-CA M10) at either a physician or hospital visit. We additionally applied a more restrictive case definition of gout comprised of individuals with at least two recorded principal diagnoses of gout from an outpatient visit on separate dates or at least one recorded principal diagnosis of gout from a hospital visit over the study period.…”

Clinical characteristics of early- and late-onset gout

“…[1] Gout has been commonly believed to be a disease of elderly men, with an average onset age of 60 years or more. [2] In contrast, in recent years, Chen et al [3] and Yu [4] found a trend of earlier gout onset in Taiwan, and Kuo et al [5] reported a second peak of incidence at 30 to 39 years of age and a trend of younger disease onset. Studies on early-onset gout, however, are lacking.…”

Update on hyperuricaemia and gout with evidence based management guidelines

“…An analysis of the National Health Insurance Research Database of over 23 million people in Taiwan showed a prevalence of gout of 6.24%. 1 A rise in the prevalence has also been reported in the developing world. In 1980 gout was rare in Eastern China but recent surveys show that the prevalence has risen to 1.14%.…”

“…21,22 More recent analyses of large databases showed a rise in the peak age incidence to 65-84 years in the UK and 70-85 years in Taiwan. 1,2,12 Increased mortality and co-morbidities in patients with hyperuricaemia and gout…”