To investigate the relationship between uric acid (UA) control in patients with gout and all-cause and cardiovascular mortality in U.S. adults and clarify sex differences.

The study population included 57,381 adults from the US National Health and Nutrition Examination Survey conducted between 2007 and 2018. Participants were divided into four mutually exclusive categories: 1) participants with normal UA levels and no gout; 2) participants with only UA elevation; 3) participants with gout alone; 4) participants with both UA elevation and gout. The outcome measures were all-cause mortality and cardiovascular mortality, defined using ICD-10 coding. Kaplan-Meier curves and a multivariate Cox proportional hazards model were used to assess the association between UA control and mortality risk among patients with gout, and subgroup analyses were conducted.

From 2007 to 2018, the overall standardized prevalence of gout increased from 4.23% to 5.08%, Among them, men have about double the burden than women. Meanwhile, the overall standardized prevalence of UA elevation remained stable. Additionally, the age-standardized prevalence of uncontrolled UA in gout patients increased from 0.46% to 0.73%, while the controlled prevalence increased from 0.52% to 1.00%. Interestingly, among male gout patients, UA levels were uncontrolled in all cases. Overall, 77.3% of participants had normal UA levels and no gout, 18.7% had only UA elevation, 2.2% had only gout, and 1.8% had both UA elevation and gout. During a median follow-up of 7.25 years, a total of 2,322 deaths occurred. Using a Cox proportional-hazards model, those with both UA elevation and gout were predicted to have a higher risk of all-cause mortality (HR 1.46, 95% CI 1.18 to 1.82) and cardiovascular mortality (HR 1.40, 95% CI 0.99 to 1.98) compared with those with normal UA levels and no gout. Meanwhile, the all-cause mortality risk among those with UA-elevated gout was 37% higher than among those with only gout, but the cardiovascular mortality risk was similar. A Kaplan-Meier curve showed that the overall survival curve for gout patients with or without UA control was similar for both all-cause and cardiovascular mortality, and was better than that of individuals with normal UA levels and no gout or only UA elevation. Subgroup analysis found that women with uncontrolled UA in gout had the worst all-cause mortality survival.

As shown in nationally representative samples of American adult survey participants, the age-standardized prevalence rates for gout, elevated UA levels, and their coexistence have shown a rising trend over the period from 2007 to 2016, with men bearing a double burden compared to women. Having gout indicates a higher risk of all-cause and cardiovascular mortality (regardless of UA level control), with uncontrolled gout among female patients resulting in even higher death risks. This underscores the urgent need for relevant interventions to control gout and extend healthy lifespan.