PLoS One. 2026 Feb 25;21(2):e0337714. doi: 10.1371/journal.pone.0337714. eCollection 2026.
ABSTRACT
BACKGROUND: Hyperuricemia is a metabolic disorder linked to gout, kidney disease, and cardiovascular complications. Understanding its prevalence and risk factors across demographic groups is crucial for effective prevention and management.
OBJECTIVES: To evaluate the prevalence of hyperuricemia among U.S. adults by sex, age, and racial/ethnic groups, and identify common and sex-specific risk factors.
METHODS: Data from 34,144 U.S. adults aged ≥20 years, obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, were analyzed. Hyperuricemia was defined as serum uric acid levels >7.0 mg/dL in males and >6.0 mg/dL in females. Prevalence estimates were calculated, and multivariate logistic regression models identified risk factors, adjusting for confounders such as body mass index (BMI), alcohol consumption, hypertension, renal function, and other variables. A sensitivity analysis excluding participants with a history of gout was conducted to evaluate the robustness of identified associations.
RESULTS: The overall prevalence of hyperuricemia was significantly higher in males (21.1%) compared to females (17.1%, P < 0.001). Females surpassed males in both prevalence and absolute numbers after age 50-59; by age ≥ 80, the number of female cases was more than twice that of males. Non-Hispanic Black adults had the highest prevalence (23.9% in males, 23.4% in females). Key risk factors for both sexes included obesity (OR = 3.91 in males; OR = 4.76 in females), hypertension (OR = 1.65 in males; OR = 2.09 in females), and impaired renal function (eGFR < 30 mL/min/1.73 m²: OR = 3.72 in males; OR = 15.37 in females). Alcohol consumption was positively associated with hyperuricemia in males (OR = 1.25), but not significantly so in females. Diabetes showed opposite associations: protective in males (OR = 0.72) but a risk factor in females (OR = 1.22). Medication use exhibited expected directional effects: diuretic use was associated with significantly increased risk of hyperuricemia (OR = 2.67 in males; OR = 2.55 in females), while urate-lowering therapy was associated with reduced risk (OR = 0.57 in males; OR = 0.55 in females).
CONCLUSIONS: Hyperuricemia remains highly prevalent in the U.S., with notable disparities by sex, age, and race/ethnicity. Older women bear a particularly high burden, partly due to obesity, renal dysfunction, and diuretic use. Incorporating medication use into analyses strengthens the evidence for sex-specific risk profiles. These findings highlight the importance of considering targeted screening and prevention strategies in specific high-risk groups, such as older women and patients receiving diuretics.
PMID:41739756 | DOI:10.1371/journal.pone.0337714