Trends and Disparities in Gout-Related Mortality in the United States, 1999-2024: A Multiple-Cause-of-Death and Joinpoint Regression Analysis.

Introduction Gout is the most common inflammatory arthritis and clusters with cardiometabolic and renal disease, yet population-level trends in gout-related mortality spanning the pre-pandemic and COVID-19 periods have not been characterized. We described United States gout-related mortality from 1999 to 2024, modeled its temporal trends overall and across demographic and regional strata, and profiled co-occurring causes of death. Methods In a retrospective serial cross-sectional analysis of the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database, we identified deaths with any mention of gout (International Classification of Diseases, Tenth Revision (ICD-10) M10.0-M10.4, M10.9) in the underlying or contributing cause-of-death fields for 1999-2024, combining the 1999-2020 bridged-race and 2021-2024 single-race files. Age-adjusted mortality rates (AAMRs), standardized to the 2000 US standard population, were analyzed with the National Cancer Institute Joinpoint Regression Program (version 6.0.1, National Cancer Institute, Bethesda, Maryland) to estimate the annual percent change (APC) per segment and the average annual percent change (AAPC) across 1999-2024. Eight prespecified co-occurring conditions were described. Results A total of 55,721 gout-related deaths were identified. Decedents were predominantly male (67.0%), non-Hispanic White (74.3%), and aged 75 years or older (68.1%). The overall AAMR was 0.57 per 100,000 in 1999 and 0.63 in 2024; the full-period AAPC was not significant (+0.30%; 95% confidence interval (CI), -0.46 to +1.07). The trend comprised four phases: a rise to 2011 (APC +1.03%), a decline to 2018 (APC -2.82%), a sharp rise to 2021 (APC +10.48%) concentrated in the pandemic years, and a decline thereafter (APC -4.76%). The pandemic-era rise was statistically significant for male, non-Hispanic Black, Hispanic, and Southern decedents but not for other strata; over the full period, only non-Hispanic Asian or Pacific Islander decedents (AAPC -2.72%) and the Midwest (AAPC -0.98%) showed a significant net change, both declines. Crude mortality rose steeply with age and increased from metropolitan to rural counties. Hypertension was the most frequent co-occurring condition (61.6%), followed by ischemic heart disease (36.2%), diabetes mellitus (28.8%), heart failure (26.4%), and renal failure (19.1%). Conclusions US gout-related mortality was stable on average between 1999 and 2024 but moved through four distinct phases, accelerated around the COVID-19 pandemic, and varied by sex, race and Hispanic origin, region, and urbanization. The trajectory tracks the cardiometabolic-renal multimorbidity that accompanies gout: these deaths are predominantly co-listed with hypertensive, cardiovascular, metabolic, and renal disease rather than attributed to gout itself. Reducing this mortality will depend less on new therapy than on delivering established gout and comorbidity care to the older, multimorbid, and underserved populations in whom these deaths are concentrated.