The Global Burden and Inequality of Gout Among the Working Age Population, 1990_2021: A Systematic Analysis from the Global Burden of Disease Study 2021

Gout is the most common inflammatory arthritis worldwide, traditionally associated with older males (2024c, 2025). However, many studies focus on the elderly, leaving a gap in understanding the burden of gout among working-age individuals. We aimed to quantify the global burden of gout in the working-age population (WAP, 15-64 years) and characterise trends, inequalities, and future projections, using Global Burden of Disease (GBD) 2021 data. We extracted GBD 2021 estimates for gout in 204 countries and territories from 1990 to 2021 for ages 15-64. Disease burden was assessed through incidence, prevalence, and years lived with disability (YLDs), along with corresponding age-standardised rates (per 100,000). Trend analysis included calculating the estimated annual percentage change (EAPC) of age-standardised rates and using join point regression to detect inflexion points. We quantified contributions of demographic drivers (population growth and ageing) versus epidemiologic changes in gout rates using decomposition analysis. Cross-national inequalities were evaluated with the Slope Index of Inequality (SII) and concentration index for gout metrics across the socio-demographic spectrum. A forecasting model (based on GBD data and a mixed-effects temporal model) projected gout burden in WAP through 2045. Globally in 2021, there were 6.08 million (95% UI: [~]5.5-6.6) new gout cases and 32.7 million (UI: [~]30-35) prevalent gout cases among people aged 15-64 years. The age-standardised incidence rate (ASIR) was approximately 105 per 100,000, and the age-standardised prevalence rate (ASPR) was about 510 per 100,000 in 2021. These rates rose modestly since 1990 (EAPCs [~]0.5-0.8%/year), reflecting a gradual upward trend. No major joinpoints were indicated to have sudden trend shifts over the 1990-2021 period. Males in the working-age group had about 3-fold higher gout prevalence than females, mirroring known sex disparities. High-income regions (e.g., Australasia and North America) exhibited the highest WAP gout rates. In contrast, some low-income areas (e.g., parts of sub-Saharan Africa and Latin America) had the lowest. A moderate positive correlation between national gout burden and Socio-demographic Index (SDI) was observed. Health disparities widened over time: the gout concentration index increased, indicating the disease became more unequally distributed, disproportionately affecting higher-SDI populations by 2021. From 1990 to 2021, the total number of WAP gout cases increased substantially. Decomposition analysis revealed that population growth accounted for [~]54.4% of this increase, with population ageing and rising age-specific gout prevalence contributing [~]20% and [~]25%, respectively (Table 1). We project that by 2045, the number of working-age gout cases will rise to [~]45 million, a 40% increase from 2021. Despite growing absolute cases, age-standardised rates are expected to stabilise or increase only slightly in the coming decades, assuming current trends hold. The burden of gout in working-age adults has increased globally over the past three decades and is expected to continue growing due to demographic expansion. This first comprehensive analysis of the working-age population reveals that gout is not merely a disease of the elderly - a majority of global cases occur before the age of 65, with significant implications for productivity and healthcare systems. Urgent, age-targeted prevention strategies (e.g. obesity and metabolic syndrome management) and improved access to care for younger gout patients are warranted to curb the rising burden and reduce future disability.