Article Text

Download PDFPDF
Extended report
Mortality due to coronary heart disease and kidney disease among middle-aged and elderly men and women with gout in the Singapore Chinese Health Study
  1. Gim Gee Teng1,
  2. Li-Wei Ang2,
  3. Kenneth G Saag3,
  4. Mimi C Yu4,
  5. Jian-Min Yuan5,
  6. Woon-Puay Koh6
  1. 1University Medicine Cluster, Division of Rheumatology, National University Health System, Singapore
  2. 2Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore
  3. 3Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
  5. 5Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
  6. 6Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  1. Correspondence to Dr Woon-Puay Koh, Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore; woon_puay_koh{at}


Objectives Whether the link between gout and mortality is causal or confounded by lifestyle factors or comorbidities remains unclear. Studies in Asia are warranted due to the rapid modernisation of the locale and ageing of the population.

Methods The association between gout and mortality was examined in a prospective cohort, the Singapore Chinese Health Study, comprising 63 257 Singapore Chinese individuals, aged 45–74 years during the enrolment period of 1993–8. All enrollees were interviewed in person on lifestyle factors, current diet and medical histories. All surviving cohort members were contacted by telephone during 1999–2004 to update selected exposure and medical histories (follow-up I interview), including the history of physician-diagnosed gout. Cause-specific mortality in the cohort was identified via record linkage with the nationwide death registry, up to 31 December 2009.

Results Out of 52 322 participants in the follow-up I interview, 2117 (4.1%) self-reported a history of physician-diagnosed gout, with a mean age at diagnosis of 54.7 years. After a mean follow-up period of 8.1 years, there were 6660 deaths. Relative to non-gout subjects, subjects with gout had a higher risk of death (HR 1.18; 95% CI 1.06 to 1.32), and specifically from death due to coronary heart disease (CHD) (HR 1.38, 95% CI 1.10 to 1.73) and kidney disease (HR 5.81, 95% CI 3.61 to 9.37). All gout–mortality risk associations were present in both genders but the risk estimates appeared higher for women.

Conclusion Gout is an independent risk factor for mortality, and specifically for death due to CHD and kidney disease.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was supported by the National Institutes of Health (grant numbers R01-CA55069, R35-CA53890, R01-CA80205 and R01-CA98497).

  • Competing interests None.

  • Ethics approval The study was approved by the the institutional review boards of the National University of Singapore and the University of Minnesota.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.