The gout epidemic in French Polynesia: a modelling study of data from the Ma'i u'u epidemiological survey

Background Gout is the most common cause of inflammatory arthritis worldwide, particularly in Pacific regions. We aimed to establish the prevalence of gout and hyperuricaemia in French Polynesia, their associations with dietary habits, their comorbidities, the prevalence of the HLA-B*58:01 allele, and current management of the disease. Methods The Ma'i u'u survey was epidemiological, prospective, cross-sectional, and gout -focused and included a random sample of adults from the general adult population of French Polynesia. It was conducted and data were collected between April 13 and Aug 16, 2021. Participants were randomly selected to represent the general adult population of French Polynesia on the basis of housing data collected during the 2017 territorial census. Each selected household was visited by a research nurse from the Ma'i u'u survey who collected data via guided, 1-h interviews with participants. In each household, the participant was the individual older than 18 years with the closest upcoming birthday. To estimate the frequency of HLA-B*58:01, we estimated HLA-B haplotypes on individuals who had whole-genome sequencing to approximately 5x average coverage (mid -pass sequencing). A subset of individuals who self -reported Polynesian ancestry and not European, Chinese, or other ancestry were used to estimate Polynesian -ancestry specific allele frequencies. Bivariate associations were reported for weighted participants; effect sizes were estimated through the odds ratio (OR) of the association calculated on the basis of a logistic model fitted with weighted observations. Findings Among the random sample of 2000 households, 896 participants were included, 140 individuals declined, and 964 households could not be contacted. 22 participants could not be weighted due to missing data, so the final weighted analysis included 874 participants (449 [51<middle dot>4%] were female and 425 [48<middle dot>6%] were male) representing the 196 630 adults living in French Polynesia. The estimated prevalence of gout was 14<middle dot>5% (95% CI 9<middle dot>9-19<middle dot>2), representing 28 561 French Polynesian adults, that is 25<middle dot>5% (18<middle dot>2-32<middle dot>8) of male individuals and 3<middle dot>5% (1<middle dot>0-6<middle dot>0) of female individuals. The prevalence of hyperuricaemia was estimated at 71<middle dot>6% (66<middle dot>7-76<middle dot>6), representing 128 687 French Polynesian adults. In multivariable analysis, age (OR 1<middle dot>5, 95% CI 1<middle dot>2-1<middle dot>8 per year), male sex (10<middle dot>3, 1<middle dot>8-60<middle dot>7), serum urate (1<middle dot>6, 1<middle dot>3-2<middle dot>0 per 1 mg/dL), uraturia (0<middle dot>8, 0<middle dot>8-0<middle dot>8 per 100 mg/L), type 2 diabetes (2<middle dot>1, 1<middle dot>4-3<middle dot>1), BMI more than 30 kg/m2 (1<middle dot>1, 1<middle dot>0-1<middle dot>2 per unit), and percentage of visceral fat (1<middle dot>7, 1<middle dot>1-2<middle dot>7 per 1% increase) were associated with gout. There were seven heterozygous HLA-B*58:01 carriers in the full cohort of 833 individuals (seven [0<middle dot>4%] of 1666 total alleles) and two heterozygous carriers in a subset of 696 individuals of Polynesian ancestry (two [0<middle dot>1%]). Interpretation French Polynesia has an estimated high prevalence of gout and hyperuricaemia, with gout affecting almost 15% of adults. Territorial measures that focus on increasing access to effective urate-lowering therapies are warranted to control this major public health problem. Funding Variant Bio, the French Polynesian Health Administration, Lille Catholic University Hospitals, French Society of Rheumatology, and Novartis. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY -NC -ND 4.0 license.