Men Have Substantially Higher Gout Incidence Than Women
Yes, men have a significantly higher incidence of gout compared to women, with approximately a 1.5:1.0 male-to-female ratio documented across multiple populations worldwide. 1
Epidemiological Evidence
Gender-Specific Incidence Patterns
Men consistently demonstrate higher gout incidence rates across all geographic regions and populations studied, with the male-to-female ratio approximating 1.5:1.0 1
Men typically have higher baseline serum uric acid levels than women, which explains the differential risk and necessitates gender-specific reference ranges in laboratory testing 2
The protective effect of estrogen in premenopausal women provides a uricosuric effect that keeps uric acid levels lower, but this protection is lost after menopause 3
Age-Related Differences
Women develop gout significantly later in life compared to men, with 91% of women developing gout after menopause onset 4
The mean age of gout onset in women is approximately 71 years compared to 61 years in men (p < 0.001) 5
After menopause, the incidence of gout rises substantially in women as estrogen's protective uricosuric effects diminish 3
Magnitude of Risk by Serum Uric Acid Levels
Gender-Specific Risk Stratification
For women with serum uric acid >6 mg/dL, the risk of developing gout is 17 times higher compared to those with lower levels 6, 2
For men with serum uric acid >6 mg/dL, the risk is 4.5 times higher compared to those with lower levels 6
Despite women showing a higher relative risk multiplier at elevated uric acid levels, the overall magnitude of association between uric acid and gout risk is actually lower in women than men (P for interaction = 0.0002) 7
The incidence rates per 1,000 person-years for women according to uric acid levels demonstrate a clear dose-response: 0.8 (<5.0 mg/dL), 2.5 (5.0-5.9 mg/dL), 4.2 (6.0-6.9 mg/dL), 13.1 (7.0-7.9 mg/dL), and 27.3 (≥8.0 mg/dL) 7
Gender-Specific Risk Factor Profiles
Risk Factors More Prominent in Women
Diuretic use is significantly more common in women with gout compared to men (p < 0.001), and appears to be a major precipitating factor independent of age effects 4, 5
Renal insufficiency is more frequently present in women with gout compared to men, even when controlling for age at onset 4
Women show greater associated risk with higher consumption of fish and shellfish (HR 1.36,95% CI 1.12-1.65) compared to men (HR 1.02,95% CI 0.86-1.22) 8
Women with gout have a greater burden of comorbid conditions including hypertension, diabetes, renal disease, and obesity compared to men (p < 0.001 for all) 5
Risk Factors More Prominent in Men
Metabolic syndrome presents significant risk for incident gout in men (HR 1.37,95% CI 1.20-1.58) but shows no significant risk in women (>50 years: HR 1.15,95% CI 0.85-1.54; ≤50 years: HR 1.29,95% CI 0.76-2.17) 8
Men more frequently have identifiable dietary triggers and alcoholism as precipitating factors for acute gout attacks 4
Alcohol consumption ≥7 ounces of pure alcohol per week confers a multivariate relative risk of 3.10 for women, though this risk factor is documented in both genders 7
Clinical Presentation Differences
Articular Manifestations
Women more frequently present with polyarticular involvement (57%) compared to the typical monoarticular presentation 4
Women more commonly manifest an underlying arthropathy (70%), usually osteoarthritis, complicating the clinical picture 4
Despite these differences, the distribution of joint involvement, presence of tophi (26% in women), and mean serum urate concentrations are remarkably similar between genders 4
Clinical Implications for Practice
Diagnostic Considerations
The later age of onset in women may lead to delayed diagnosis, as gout may not be considered as readily in elderly women with polyarticular arthritis 4, 5
Crystal identification remains the gold standard for diagnosis in both genders, as serum uric acid levels alone are insufficient 9
Clinicians should maintain high suspicion for gout in postmenopausal women, particularly those on diuretics or with renal insufficiency 4
Treatment Approach
The target serum uric acid level of <6 mg/dL applies equally to both men and women 6
Risk factor modification should be tailored by gender: emphasize metabolic syndrome management in men and diuretic alternatives plus renal function monitoring in women 8, 5
Both genders benefit from similar urate-lowering therapy strategies, though women's greater comorbidity burden requires more careful medication selection 5