Background/Purpose: Gout is the most common inflammatory arthritis and an important driver of chronic disability. However, long-term trends in gout burden across U.S. states are not well-characterized. Using nationally representative data, we aimed to quantify changes in age-standardized gout-related disability-adjusted life years (DALYs), years lived with disability (YLDs), and prevalence rates between 2001 and 2021, with a focus on regional disparities.

Methods: We extracted age-standardized DALY, YLD, and prevalence rates for gout from the Global Burden of Disease 2021 dataset for adult patients. Annual rates per 100,000 population were obtained for all 50 U.S. states and the national average from 2001 to 2021. We calculated national trends with 95% confidence intervals (CIs) and computed percent change in burden over time for each state. The ten states with the highest burden in 2021 were identified.

Results: Between 2001 and 2021, the national average DALY rate for gout increased from 53.1 (95% CI: 51.4–54.8) to 102.9 (95% CI: 99.4–106.4) per 100,000—a 93.7% increase. The YLD rate mirrored this trend, rising from 53.1 (95% CI: 51.4–54.8) to 102.9 (95% CI: 99.4–106.4). The prevalence rate more than doubled, from 1,677.2 to 3,408.9 per 100,000 (+103.2%). In 2021, the states with the highest DALY and YLD rates included Hawaii (147.7, +93.3%), South Carolina (124.7, +107.4%), Alabama (123.0, +114.0%), and Louisiana (120.4, +99.6%). Prevalence rates followed a similar pattern, with Hawaii (4,902.4, +98.6%), South Carolina (4,185.0, +114.0%), and Alabama (4,104.9, +118.2%) ranking among the highest. All ten highest-burden states demonstrated steep upward trajectories over the two-decade period (Figure 1). Regional clustering was evident, with the Southeast disproportionately represented (Figure 2).

Conclusion: The prevalence and disability burden of gout in the United States have more than doubled over the past 20 years. DALY and YLD rates show that the impact of gout extends beyond symptoms, contributing significantly to long-term health loss. Southern and Western states carry the highest burden, emphasizing the need for targeted public health strategies.

Trends in gout burden among the top 10 most affected U.S. states, 2001–2021.

Geographic variation in gout burden across U.S. states in 2021.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/twenty-year-trends-in-the-u-s-burden-of-gout-a-state-level-analysis-of-disability-and-prevalence-from-2001-to-2021/