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. 2011 Oct 27;11:832. doi: 10.1186/1471-2458-11-832

The prevalence of hyperuricemia in China: a meta-analysis

Liu B 1,#, Wang T 1,#, Zhao HN 1, Yue WW 1, Yu HP 1, Liu CX 1, Yin J 1, Jia RY 1,✉, Nie HW 2
PMCID: PMC3213156  PMID: 22032610

Abstract

Background

The prevalence of hyperuricemia varied in different populations and it appeared to be increasing in the past decades. Recent studies suggest that hyperuricemia is an independent risk factor for cardiovascular disease. However, there has not yet been a systematic analysis of the prevalence of hyperuricemia in China.

Methods

Epidemiological investigations on hyperuricemia in China published in journals were identified manually and on-line by using CBMDISC, Chongqing VIP database and CNKI database. Those Reported in English journals were identified using MEDLINE database. Selected studies had to describe an original study defined by strict screening and diagnostic criteria. The fixed effects model or random effects model was employed according to statistical test for homogeneity.

Results

Fifty-nine studies were selected, the statistical information of which was collected for systematic analysis. The results showed that the pooled prevalence of hyperuricemia in male was 21.6% (95%CI: 18.9%-24.6%), but it was only 8.6% (95%CI: 8.2%-10.2%) in female. It was found that thirty years was the risk point age in male and it was fifty years in female.

Conclusions

The prevalence of hyperuricemia is different as the period of age and it increases after 30 years in male and 50 in female. Interventions are necessary to change the risk factors before the key age which is 30 years in male and 50 in female.

Background

Hyperuricemia (HU) is a result of multifactor interactions including gender, age, genetic and environmental factors. Classically, the following conditions are associated with HU: alcoholism, obesity, hypertension, dyslipidemia, hyperglycemia, diabetes mellitus, lithiasis, renal failure, and medication use (diuretics, cyclosporine, low-dose aspirin) [1]. In the past several decades, the prevalence varied greatly and appeared to be increasing. There was lots information that demonstrated the importance of serum uric acid to the clinical prognosis, so the importance of HU is increasing. It reported that 18.8% of the patients with HU developed into gout in a 5 year follow-up [2]. Independent association between HU and cardiovascular disease has been found in many studies [3,4]. Hyperuricemia has been reported to be associated with several components of metabolic syndrome (MetS) and authors have postulated that increased concentrations of uric acid may be another important component of the syndrome [5].

With rapid economic development, possibility of improved nutrition and promotion of successful heath and medical care programs in China, life expectancy has been prolonged and the elderly population has increased; thus prevention and control of chronic diseases have become more important than before. Hyperuricemia may induce many complications, such as chronic gout, distortion of joint and renal failure, which may increase medical care costs. Therefore, it is important to study the hyperuricemia in China, in all developing countries, even in the whole world.

Methods

Search strategy

Studies were identified from the following electronic databases: CBMDISK, Chongqing VIP, CNKI and MEDLINE, using the terms 'hyperuricemia', 'HU' and 'prevalence'. No attempt was made to retrieve unpublished studies. The study did not include epidemiological studies in the areas of Hong Kong, Macao and Taiwan, because they are different from the Chinese mainland in the cultural activity and socioeconomic status and hence the prevalence of hyperuricemia and gout in those areas would be different from the Chinese mainland.

Inclusion and exclusion criteria

In order to meet the analysis requirements and reduce deviation, selected studies fulfilled the following criteria: (i) case collection based on field survey; (ii) the study based on population samples rather than volunteers; (iii) There should be validated diagnostic criteria and accurate study dates; (iv) If there were many articles based on the same sample, only the one that reported the most detailed data was included. It was confirmed that all articles had the same diagnostic criteria. Studies were excluded if we could not obtain information necessary for the computation of prevalence in different sex and age from the articles or the authors.

Quality of the studies

We accessed the quality of studies using the framework suggested by the Cochrane Collaboration. For the inclusion decision, quality assessment was carried out independently by three reviewers. If two of them or three agreed, the study can be included to the meta-analysis. The data from all included studies were clearly tabulated, and deviations were taken into account and identified during the quality assessment stage.

Data analysis

We used a published systematic analysis technique to calculate the pooled prevalence of hyperuricemia and gout from all eligible studies. Summary of prevalence estimates were obtained using fixed-effects or random-effects meta-analysis which determined by I2. Statistical heterogeneity was assessed through I2 statistic and its values of 25%, 50% and 75% correspond to low, moderate and high heterogeneity. The date which was low heterogeneity was chose the fixed-effects meta-analysis and others were chose random-effects meta-analysis. Subgroup analysis including sexes, ages and areas was also performed.

Results

Figure 1 summarized the process of identifying eligible epidemiological studies. There were 59 [6-64] studies left after the quality assessment. Table 1 showed the characteristics of the studies, which covered 23 provinces in the review. The prevalence of HU and 95%CI in male and female were calculated separately for each study, also the sample size and published years can be found (Figure 2, Figure 3). The male population of 223,315 was investigated, and cases of 52,998 HU were selected. It was 165,620 in female, and cases of 19,586 HU were selected. The pooled prevalence of hyperuricemia in male was 21.6% (95%CI: 18.9%-24.6%) and it was only 8.6% (95%CI: 8.2%-10.2%) in female (Table 2), it was also found that the prevalence in female was lower than that in male in every age group. Table 2 also showed the prevalence of hyperuricemia in different gender and area. Heterogeneity of the analysis was moderate. The prevalence ranged from 8.4% to 8.6% in female, and it ranged from 19.6% to 26.8% in male. Table 3 demonstrated the prevalence of hyperuricemia in different age and area. It was found that thirty was the risk point age in male and it was fifty in female. The prevalence of female in northern and eastern China was 2.6% in ~30 age group, and it was high to 31.2% in western China of male in 51-60 age group.

Figure 1.

Figure 1

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Flow of information through the different phases of a systematic review.

Table 1.

Characteristics of the studies

Study design
NO. First author
& year
published		 Age Location
(Western/Eastern)
(Northern/Southern)		 Survey date Diagnostic criterion
(μmol/L)
(Male/Female)		 Hyperuricemia no.(Male/Femal) Subjects no.
(Male/Female)		 Prevalence
(%)(Male/
Female)
1[6] Miao et al.(2006) 20-80 Shandong(E) May 1995 - Aug 1996 >420/>350 435/225 2395/2608 18.16/8.63
2[7] Du et al.(1998) ≥15 Shanghai(E) Nov 1996 - Aug 1997 >417/>357 62/41 913/1124 6.79/3.65
3[8] Huang et al.(2006) ≥20 Jiangsu(E) Jan 2000-Apr 2006 ≥416.5/≥357 493/80 4950/1737 9.96/4.61
4[9] Li et al.(2002) 36-90 Henan(E) May 2000 >416/>357 210/24 737/142 28.49/16.90
5[10] He et al.(2003) 20-72 Sichuan(W) 2002 ≥420/≥360 552/75 1378/1108 40.06/6.77
6[11] Shao et al.(2003) ≥20 Jiangsu(E) Dec 2002-Mar 2003 ≥417/≥357 668/370 3790/3988 17.63/9.28
7[12] Wang et al.(2004) ≥40 Liaoning(E) ----- >416/>357 192 1000 19.2
8[13] Yu et al.(2005) 21-83 Guangdong(E) Jan 2003-Mar2004 ≥417/≥357 1655/697 7330/5994 22.59/11.63
9[14] Yu et al.(2005) 22-81 Guangdong(E) Jan 2003-June2004 ≥417/≥357 819/363 4106/3321 19.95/10.93
10[15] Zhang et al.(2006) 20-91 Shandong(E) Mar 2003-Dec 2004 >416.36/>356.88 424/225 2517/2855 16.85/7.88
11[16] Gu et al.(2006) 20-80 Guangdong(E) 2004 ≥417/≥357 4496/1304 16115/10506 27.90/12.41
12[17] Zhang et al.(2007) 28-88 Gansu(W) 2004 >440/>350 389/68 2372/360 16.40/18.89
13[18] Luan et al.(2007) 21-72 Tibet(W) Oct 2004 - Dec 2004 ≥440/≥360 454/25 537/159 84.54/15.72
14[19] Yao et al.(2007) ≥18 Shanghai(E) Oct 2004 - June 2005 ≥417/≥357 273/36 2965/2693 9.21/1.34
15[20] Li et al.(2007) 20-59 Ningxia(W) Jan 2004 - Dec 2005 >420/>350 410 9358 4.38
16[21] Zeng et al.(2005) 18-85 Guangxi(W) Jan 2004 - Aug 2005 ≥417/≥357 490/170 2800/2400 17.50/7.08
17[22] Mao et al.(2006) ≥20 Zhejiang(E) Apr 2004-Dec2004 ≥416/≥357 1214/160 7566/3450 16.05/4.64
18[23] Diao et al.(2005) 20-79 Guangdong(E) June 2004-June 2006 >357 0/853 0/7226 0/11.80
19[24] Li et al.(2009) 22-60 Qinghai(W) 2004-2007 >420/>350 134/2 819/275 16.36/0.73
20[25] Wu et al.(2007) 21-67 Zhejiang(E) 2005-2006 ≥416/≥357 250 1492 16.76
21[26] Sun et al.(2007) 20-70 Xinjiang(W) Jan2005 - Dec2005 >417/>357 104/18 379/315 27.44/5.71
22[27] Xie et al.(2008) 18-92 Chongqing(W) June2005 - Dec2005 >380/>300 1244/483 5962/3566 20.87/13.54
23[28] Fang et al.(2006) 20-90 Beijing(E) Sept2005 - Dec2005 ≥416.4/≥356.9 163/46 1181/762 13.80/6.04
24[29] Cao et al.(2009) >20 Zhejiang(E) 2005-2007 ≥417/≥357 2516/651 9615/7639 26.17/8.52
25[30] Wu et al.(2007) 19-87 Guangdong(E) ------ ≥417/≥357 258/93 911/571 28.32/16.29
26[31] Li et al.(2008) >60 Guangdong(E) 2006 >420 156/45 519/425 30.06/10.59
27[32] Jin et al.(2007) 26-57 Jilin(E) ------ ≥408/≥357 97/2 350/32 27.71/6.25
28[33] Chen et al.(2009) >20 Yunnan(W) Jan 2006 - Dec 2006 >420/>350 580/343 3593/3912 16.14/8.77
29[34] Wu et al.(2008) >16 Guangdong(E) Nov2006-Feb2007 ≥417/≥357 369/217 1366/1422 27.01/15.26
30[35] Zeng et al.(2008) 22-79 Hunan(W) Dec 2006 - Jan 2007 ≥417/≥357 405/103 1346/994 30.09/10.36
31[36] Wanget al.(2008) 20-78 Heilongjiang(E) Feb2006 - Jan 2008 ≥417/≥357 502/125 2390/1824 21.00/6.85
32[37] Tian et al.(2008) ≥35 Shanghai(E) Mar2006 - Sept2006 >420/>350 425/451 1887/2943 22.52/15.32
33[38] Wei et al.(2008) 20-70 Hebei(E) May2006 - Dec 2006 ≥420/≥350 197/86 1146/859 17.19/10.01
34[39] Deng et al.(2007) 41-93 Liaoning(E) Sept2006 - Nov2006 >416/>339 250/45 936/218 26.71/20.64
35[40] Wen et al.(2007) 35-64 Shandong(E) Sept2006 - Dec 2006 ≥417/≥357 126/44 1979/2062 6.37/2.13
36[41] Zeng et al.(2009) ≥20 Zhejiang(E) 2006-2007 ≥417/≥357 1797/520 6591/5649 27.26/9.21
37[42] Zhong et al.(2008) 22-92 Hunan(W) 2007 ≥420/≥360 178/34 919/497 19.37/6.84
38[43] Zheng et al.(2008) 20-92 Guangdong(E) 2007 ≥420/≥350 4355/1239 18589/10526 23.43/11.77
39[44] Huang et al.(2009) 60-90 Shanghai(E) 2007 ≥420/≥360 288/139 1423/1466 20.24/9.48
40[45] Chen et al.(2008) 20-90 Chongqing(W) 2007 ≥417/≥357 4772/951 8352/7471 57.14/12.73
41[46] Liu et al.(2008) ≥60 Zhejiang(E) Oct2007 - Feb2008 >420 445/213 1964/3321 22.66/6.41
42[47] Jia et al.(2009) 20-101 Hebei(E) Jan2007-Nov2007 >401.52/>249.20 802/180 6703/1832 11.96/9.83
43[48] Han et al.(2008) 19-87 Beijing(E) Jan2007-Nov2007 ≥417/≥357 139/61 540/580 25.74/10.52
44[49] Yuan et al.(2009) 20-85 Zhejiang(E) Nov 2007 - Dec2007 ≥417/≥357 1607/243 4958/2562 32.41/9.48
45[50] Gao et al.(2008) 18-94 Anhui(W) Jan2007 - Dec 2007 >429/>340 2883/609 26066/13758 11.06/4.43
46[51] Wu et al.(2009) 23-59 Guangxi(W) Jan2007 - May2009 >420/>360 111/20 825/407 13.45/4.91
47[52] Yang et al.(2009) 24-67 Tibet (W) Jan2007 - May2009 ≥417/≥357 646/136 1874/993 34.53/13.70
48[53] Wang et al.(2008) 45-96 Zhejiang(E) Jan2007 - June 2007 ≥420/≥360 690/335 1796/3341 38.42/10.03
49[54] Quan et al.(2008) 32-77 Jilin(E) Mar 2007 ≥420/≥350 42/29 468/686 8.97/4.23
50[55] Liu et al.(2008) 27-82 Liaoning(E) Apr 2007 - Apr 2008 >420/>350 220/139 1144/923 19.23/15.06
51[56] Wang et al.(2008) >16 Zhejiang(E) May 2007 >420/>360 126/31 518/920 24.32/3.37
52[57] Ding et al.(2008) 21-61 Jiangsu(E) May 2007 >420/>340 11/7 118/239 9.32/2.93
53[58] Zhang et al.(2009) 20-90 Guangdong(E) Sept2007-Aug2008 ≥417/≥357 1147/248 6137/2679 18.69/9.26
54[59] Huang et al.(2009) 20-80 Fujian (E) Jan2008 - Sept2008 >416/>339 9458/6046 24140/20034 39.18/30.18
55[60] Li et al.(2009) 30-69 Guangdong(E) Mar2008 - Oct2008 ≥428/≥340 2043/629 9189/7128 22.23/8.82
56[61] Wang et al.(2009) 60-98 Beijing(E) July2008 - June2009 ≥417 416/208 2295/2266 18.13/9.18
57[62] Wang et al.(2009) 19-65 Zhejiang(E) Aug2008 ≥417/≥357 191/76 599/702 31.89/10.83
58[63] Cao et al.(2010) >20 Hainan(E) Sept 2008-Nov 2008 ≥417/≥350 181/23 663/150 27.30/15.33
59[64] Jiang et al.(2010) 20-93 Beijing(E) Mar2009 - Sept2009 ≥417/≥357 290/96 2585/1722 11.22/5.57
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Figure 2.

Figure 2

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Forest plot of the studies for the male.

Figure 3.

Figure 3

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Forest plot of the studies for the female.

Table 2.

The prevalence of hyperuricemia in different gender and area

China Gender Case/Total
(No. of Studies)		 Pooled
Estimate (%)		 95%CI(%) Heterogeneity
I2 P-value
Northern
China		 Male 8923/59413(n = 21) 19.6 15.7-24.1 49.8% 0.00
Female 2393/35231(n = 21) 8.4 6.6-10.5 49.2% 0.00
Southern
China		 Male 44075/163902(n = 34) 22.7 19.6-26.1 49.9% 0.00
Female 17289/132111(n = 35) 8.8 7.1-10.8 49.9% 0.00
Eastern
China		 Male 40056/166093(n = 41) 20.1 17.8-22.6 49.8% 0.00
Female 16645/131127(n = 42) 8.6 7.0-10.6 49.8% 0.00
Western
China		 Male 12942/57222(n = 14) 26.8 17.3-39.0 50.0% 0.00
Female 3037/36215(n = 14) 8.5 6.5-11.2 49.5% 0.00
Total Male 52998/223315 (n = 55) 21.6 18.9-24.6 49.9% 0.00
Female 19586/165620 (n = 55) 8.6 7.2-10.2 49.8% 0.00
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Table 3.

The prevalence of hyperuricemia in different age

China Gender Age
~30 31-40 41-50 51-60 61-70 >70
Northern
China		 Male 11.6(8.8-15.1) 16.4(12.7-20.9) 20.9(16.0-26.7) 21.0(14.2-29.9) 17.3(14.4-20.6) 17.9(13.8-23.0)
Female 2.6(1.5-4.5) 3.8(2.4-5.9) 7.6(5.5-10.2) 14.3(9.1-21.7) 13.2(9.5-18.2) 20.2(14.4-27.6)
Southern
China		 Male 16.8(11.4-24.2) 24.4(16.3-34.9) 24.9(19.6-31.2) 23.5(19.5-27.9) 22.6(19.7-25.7) 27.2(22.5-32.4)
Female 3.1(1.8-5.4) 3.6(1.7-7.6) 6.2(3.5-10.7) 15.1(11.1-20.2) 19.8(13.6-27.8) 25.3(17.6-35.0)
Eastern
China		 Male 13.1(9.5-17.7) 17.4(13.4-22.2) 20.4(16.7-24.7) 19.6(16.4-23.2) 19.9(17.3-22.8) 24.2(21.0-27.7)
Female 2.6(1.5-4.6) 3.5(2.6-6.7) 6.8(4.2-10.6) 12.4(9.4-16.2) 15.3(10.7-21.6) 22.4(16.2-30.0)
Western
China		 Male 17.5(6.3-40.1) 29.9(8.3-67.0) 31.0(18.8-46.4) 31.2(18.9-46.9) 25.6(18.7-27.0) 24.6(10.3-48.1)
Female 4.7(3.4-6.5) 4.2(2.6-6.7) 7.5(5.2-10.6) 22.9(11.7-39.8) 24.6(16.1-35.6) 31.1(24.5-38.6)
Total Male 14.2(10.4-19.2) 20.1(15.3-26.0) 22.9(18.9-27.5) 22.3(18.8-26.2) 23.3(18.0-24.9) 24.1(20.6-28.0)
Female 2.8(1.8-4.5) 3.5(2.0-6.2) 6.6(4.5-9.7) 14.7(11.5-18.6) 16.8(12.5-22.4) 23.4(17.7-30.4)
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Note: The I2 of all studies in the table ranged from 45% to 50%.

Discussion

The prevalence of hyperuricemia varies in different populations and areas. In Turkey [65], one study reported that 19% of the men and 5.8% of the women had hyperuricemia and the overall prevalence of hyperuricemia was 12.1% in the urban population. In Nepal [66], 3794 people which were from Chitwan districts were investigated, and the prevalence of hyperuricemia was 21.42%. In Seychelle [67], the cross-sectional health examination survey based on a population random sample which included 1011 subjects aged 25 to 64 years showed that the prevalence of hyperuricemia was 35.2% and 8.7% in men and women, respectively. In Thailand [68], an across-sectional study of 1381 patients who firstly participated in annual health examinations during the period of July 1999 through February 2000 reported that the prevalence of hyperuricemia was 10.6%, but it was 18.4% and 7.8% in men and women, respectively. In Java [69], the prevalence of hyperuricemia was investigated by a survey of a total population of 4683 rural adults and the result was 24.3%. In United States [70], the prevalence rate of asymptomatic hyperuricemia in the general population was estimated at 2-13%. The prevalence of gout and/or hyperuricemia increased about 2 cases per 1000 enrollees over 10 year (1990-1999) in the overall population. In Japan [71], a total of 9,914 individuals (6,163 men and 3,751 women aged from 18 to 89 years) who were screened at Okinawa General Health Maintenance Association was screened. The result showed that the prevalence of hyperuricemia was 25.8% and it was 34.5%, 11.6% in men and women respectively. In New Zealand [72], hyperuricemia was more common in Maori men (27.1%) than in European men (9.4%) and in Maori women (26.6%) than in European women (10.5%). In Saudi Arabia [73], the prevalence of hyperuricemia was only 8.84%. In Taiwan island of China [74], the prevalence of hyperuricemia was high to 49.4% in Ayatals, but it was only 27.4% in non-aborigines.

From the analysis, it was found that age and sex affected the serum uric acid levels and the prevalence of hyperuricemia:

The factor of age

It was found that the prevalence of hyperuricemia increased with the age in male and female. The prevalence was higher in male who were after 30 years old than that younger. But the point age was 50 in female. The physiologic and economic reasons may explain this difference. After 30 years old, the male would have a stable family and career. In female, the influence of sexual hormones may explain the point age. Young children of both sexes have equally low urate levels, so the prevalence is low. The study of Katrine demonstrated that the 45-64 age group was higher prevalence compared with the 18-44 age group [75]. Vitool's study showed that the prevalence were 4.3% and 1.3% in men and women, who were younger than 18 years, but it increased to 17.4% and 15.4% in the men and women from 30 to 39 [68]. A study about elderly people in Taiwan reported that Men at age 65 to 69 had the highest proportion of hyperuricemia which was 69.8%, but woman at age more than 80 had the higher prevalence which was 50% [76].

The factor of sex

From the previous studies, it was found that serum uric acid levels were higher in men than in women, but it tended to be consistent between man and woman after the age of 50 [77,78]. The study of Gordon explained it that serum uric acid level increased after the menopause in females which attributed to the influence of sexual hormones [79]. The results of the study showed that male subjects had a higher prevalence of hyperuricemia than women, which was in line with findings of many studies from different countries [65-74].

Health Education and life customs

From the result of meta-analysis, it was found that the prevalence in different age of southern China was higher than that in northern China and the prevalence in western was higher than that in eastern, especially in male. The reason for that may be different life customs. In southern China, the mainly food is rice and it is sweat in northern China. In the eastern China, the health service is better than that in western China. More health educations were carried out and the people had more health knowledge in eastern China, which may affect the prevalence of hyperuricemia. The reasons for the difference in prevalence need further research.

Conclusions

In conclusion, aging trend is more and more serious in China, even all the word, and the prevalence of hyperuricemia is higher in elderly. It was found that urate levels correlate with many recognized cardiovascular risk factors, including hypertension, diabetes mellitus, hypertriglyceridemia, obesity and insulin resistance. Multiple Risk Factor Intervention Trial (MRFIT) database showed that hyperuricemia was an independent risk factor for acute myocardial infarction [75]. The Italian Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study showed that serum urate levels in the highest quartile were associated with increased risk of all cardiovascular events (relative risk [RR] = 1.73) and fatal cardiovascular events (RR = 1.96) compared with urate levels in the second quartile[76]. So it is important to control the prevalence in elderly. Interventions are necessary to change the risk factors before the key age which is 30 years in male and 50 in female. At the same time, intervention to high risk group is urgent.

In China, most of the studies concerned the eastern, especially in the urban areas, but it is necessary to study the western of China and rural areas. The cohort study with larger sample is necessary. This article only provides the narrowing window of hyperuricemia in China.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

LB and WT gave the biggest contributions to the passage; JRY gave the point about the passage; ZHHN, YWW, YHP, LCX, YJ helped to analysis and interpret data; NHW helped to revise the language problems. All authors read and approved the final manuscript.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2458/11/832/prepub

Contributor Information

Liu B, Email: liubin409@163.com.

Wang T, Email: wtwt128@yahoo.com.cn.

Zhao HN, Email: deararyuemoon@hotmail.com.

Yue WW, Email: yuewenwei@medmail.com.cn.

Yu HP, Email: yuhuapeng1972@163.com.

Liu CX, Email: liucui_xia@126.com.

Yin J, Email: yinjie12345@sohu.com.

Jia RY, Email: jrycardiology@sohu.com.

Nie HW, Email: niehw1985@163.com.

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