Epidemiology of gout, its treatment and comorbidities - a prospective cohort study using data from Clinical Practice Research Datalink (CPRD)

Date of Approval
Application Number
Technical Summary

Objectives: [1] To examine the temporal trend in incidence and prevalence of gout between 1997-2021. [2] To examine the temporal trend in all-cause mortality and prevalence of urate lowering treatment (ULT) prescription, ULT prescription achieving serum urate treatment target, in patients with gout between 1997-2021. [2] To examine the association between gout flares and (a) acute myocardial infarction, (b) stroke, (c) venous thromboembolism.
Design: prospective cohort study with nested cross-sectional and case-control studies.
Study period: 01/01/1997– 30/09/2021.
Data sources: Clinical Practice Research Datalink, Hospital Episode Statistics, Office for National Statistics
Methods: We will calculate the point prevalence of gout, and ULT prescription in people with gout on the 1st July of each year between 1997 and 2021. Participants in receipt of ULT prescription(s) in the 60 days preceding the 1st of July will be classified as prescribed ULT. The latest serum urate before 1st July of each year will be used to define whether the serum urate is below treatment target or not for those on ULT. Similarly, annual incidence of gout between 1997 and 2021, and mortality rate of gout cases incident in each calendar year between 1997 and 2021 will be calculated. Join Point regression will be used to examine the temporal trends. The association between acute myocardial infarction, stroke, venous thromboembolism, and gout will be assessed using nested case-control study design. The nested case-control study will include controls that are age, sex and duration of registration in CPRD matched to cases, and adjusted for covariates including demographic factors, lifestyle factors, ULT, and comorbidities. Three nested case control studies will be performed, one for each outcome of interest. Conditional logistic regression will be used to examine associations. Adjusted OR, and 95% confidence intervals (CIs) will be calculated. Data management and analysis will be performed by STATA version 16.

Health Outcomes to be Measured

• Gout – incident and prevalent
• Urate lowering treatment prescription
• Urate lowering treatment achieving serum urate treatment target (serum urate less than 300 micromol/L)
• Death
• Acute myocardial infarction
• Acute stroke
• Venous thromboembolism – defined as either deep vein thrombosis or pulmonary embolism,


Abhishek Abhishek - Chief Investigator - University of Nottingham
dalia Elmelegy - Corresponding Applicant - Nottingham University Hospitals
Anthony Avery - Collaborator - University of Nottingham
Georgina Nakafero - Collaborator - University of Nottingham
Laila Tata - Collaborator - University of Nottingham
Mamas Mamas - Collaborator - Keele University


HES Admitted Patient Care;ONS Death Registration Data;Practice Level Index of Multiple Deprivation