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The prevalence of hyperuricemia in China: a meta-analysis

  • Liu B1,
  • Wang T1,
  • Zhao HN1,
  • Yue WW1,
  • Yu HP1,
  • Liu CX1,
  • Yin J1,
  • Jia RY1Email author and
  • Nie HW2
Contributed equally
BMC Public Health201111:832

DOI: 10.1186/1471-2458-11-832

Received: 21 March 2011

Accepted: 27 October 2011

Published: 27 October 2011

Abstract

Background

The prevalence of hyperuricemia varied in different populations and it appeared to be increasing in the past decades. Recent studies suggest that hyperuricemia is an independent risk factor for cardiovascular disease. However, there has not yet been a systematic analysis of the prevalence of hyperuricemia in China.

Methods

Epidemiological investigations on hyperuricemia in China published in journals were identified manually and on-line by using CBMDISC, Chongqing VIP database and CNKI database. Those Reported in English journals were identified using MEDLINE database. Selected studies had to describe an original study defined by strict screening and diagnostic criteria. The fixed effects model or random effects model was employed according to statistical test for homogeneity.

Results

Fifty-nine studies were selected, the statistical information of which was collected for systematic analysis. The results showed that the pooled prevalence of hyperuricemia in male was 21.6% (95%CI: 18.9%-24.6%), but it was only 8.6% (95%CI: 8.2%-10.2%) in female. It was found that thirty years was the risk point age in male and it was fifty years in female.

Conclusions

The prevalence of hyperuricemia is different as the period of age and it increases after 30 years in male and 50 in female. Interventions are necessary to change the risk factors before the key age which is 30 years in male and 50 in female.

Background

Hyperuricemia (HU) is a result of multifactor interactions including gender, age, genetic and environmental factors. Classically, the following conditions are associated with HU: alcoholism, obesity, hypertension, dyslipidemia, hyperglycemia, diabetes mellitus, lithiasis, renal failure, and medication use (diuretics, cyclosporine, low-dose aspirin) [1]. In the past several decades, the prevalence varied greatly and appeared to be increasing. There was lots information that demonstrated the importance of serum uric acid to the clinical prognosis, so the importance of HU is increasing. It reported that 18.8% of the patients with HU developed into gout in a 5 year follow-up [2]. Independent association between HU and cardiovascular disease has been found in many studies [3, 4]. Hyperuricemia has been reported to be associated with several components of metabolic syndrome (MetS) and authors have postulated that increased concentrations of uric acid may be another important component of the syndrome [5].

With rapid economic development, possibility of improved nutrition and promotion of successful heath and medical care programs in China, life expectancy has been prolonged and the elderly population has increased; thus prevention and control of chronic diseases have become more important than before. Hyperuricemia may induce many complications, such as chronic gout, distortion of joint and renal failure, which may increase medical care costs. Therefore, it is important to study the hyperuricemia in China, in all developing countries, even in the whole world.

Methods

Search strategy

Studies were identified from the following electronic databases: CBMDISK, Chongqing VIP, CNKI and MEDLINE, using the terms 'hyperuricemia', 'HU' and 'prevalence'. No attempt was made to retrieve unpublished studies. The study did not include epidemiological studies in the areas of Hong Kong, Macao and Taiwan, because they are different from the Chinese mainland in the cultural activity and socioeconomic status and hence the prevalence of hyperuricemia and gout in those areas would be different from the Chinese mainland.

Inclusion and exclusion criteria

In order to meet the analysis requirements and reduce deviation, selected studies fulfilled the following criteria: (i) case collection based on field survey; (ii) the study based on population samples rather than volunteers; (iii) There should be validated diagnostic criteria and accurate study dates; (iv) If there were many articles based on the same sample, only the one that reported the most detailed data was included. It was confirmed that all articles had the same diagnostic criteria. Studies were excluded if we could not obtain information necessary for the computation of prevalence in different sex and age from the articles or the authors.

Quality of the studies

We accessed the quality of studies using the framework suggested by the Cochrane Collaboration. For the inclusion decision, quality assessment was carried out independently by three reviewers. If two of them or three agreed, the study can be included to the meta-analysis. The data from all included studies were clearly tabulated, and deviations were taken into account and identified during the quality assessment stage.

Data analysis

We used a published systematic analysis technique to calculate the pooled prevalence of hyperuricemia and gout from all eligible studies. Summary of prevalence estimates were obtained using fixed-effects or random-effects meta-analysis which determined by I2. Statistical heterogeneity was assessed through I2 statistic and its values of 25%, 50% and 75% correspond to low, moderate and high heterogeneity. The date which was low heterogeneity was chose the fixed-effects meta-analysis and others were chose random-effects meta-analysis. Subgroup analysis including sexes, ages and areas was also performed.

Results

Figure 1 summarized the process of identifying eligible epidemiological studies. There were 59 [664] studies left after the quality assessment. Table 1 showed the characteristics of the studies, which covered 23 provinces in the review. The prevalence of HU and 95%CI in male and female were calculated separately for each study, also the sample size and published years can be found (Figure 2, Figure 3). The male population of 223,315 was investigated, and cases of 52,998 HU were selected. It was 165,620 in female, and cases of 19,586 HU were selected. The pooled prevalence of hyperuricemia in male was 21.6% (95%CI: 18.9%-24.6%) and it was only 8.6% (95%CI: 8.2%-10.2%) in female (Table 2), it was also found that the prevalence in female was lower than that in male in every age group. Table 2 also showed the prevalence of hyperuricemia in different gender and area. Heterogeneity of the analysis was moderate. The prevalence ranged from 8.4% to 8.6% in female, and it ranged from 19.6% to 26.8% in male. Table 3 demonstrated the prevalence of hyperuricemia in different age and area. It was found that thirty was the risk point age in male and it was fifty in female. The prevalence of female in northern and eastern China was 2.6% in ~30 age group, and it was high to 31.2% in western China of male in 51-60 age group.
https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-11-832/MediaObjects/12889_2011_Article_3602_Fig1_HTML.jpg
Figure 1

Flow of information through the different phases of a systematic review.

Table 1

Characteristics of the studies

  

Study design

 

NO.

First author

& year

published

Age

Location

(Western/Eastern)

(Northern/Southern)

Survey date

Diagnostic criterion

(μmol/L)

(Male/Female)

Hyperuricemia no.(Male/Femal)

Subjects no.

(Male/Female)

Prevalence

(%)(Male/

Female)

1[6]

Miao et al.(2006)

20-80

Shandong(E)

May 1995 - Aug 1996

>420/>350

435/225

2395/2608

18.16/8.63

2[7]

Du et al.(1998)

≥15

Shanghai(E)

Nov 1996 - Aug 1997

>417/>357

62/41

913/1124

6.79/3.65

3[8]

Huang et al.(2006)

≥20

Jiangsu(E)

Jan 2000-Apr 2006

≥416.5/≥357

493/80

4950/1737

9.96/4.61

4[9]

Li et al.(2002)

36-90

Henan(E)

May 2000

>416/>357

210/24

737/142

28.49/16.90

5[10]

He et al.(2003)

20-72

Sichuan(W)

2002

≥420/≥360

552/75

1378/1108

40.06/6.77

6[11]

Shao et al.(2003)

≥20

Jiangsu(E)

Dec 2002-Mar 2003

≥417/≥357

668/370

3790/3988

17.63/9.28

7[12]

Wang et al.(2004)

≥40

Liaoning(E)

-----

>416/>357

192

1000

19.2

8[13]

Yu et al.(2005)

21-83

Guangdong(E)

Jan 2003-Mar2004

≥417/≥357

1655/697

7330/5994

22.59/11.63

9[14]

Yu et al.(2005)

22-81

Guangdong(E)

Jan 2003-June2004

≥417/≥357

819/363

4106/3321

19.95/10.93

10[15]

Zhang et al.(2006)

20-91

Shandong(E)

Mar 2003-Dec 2004

>416.36/>356.88

424/225

2517/2855

16.85/7.88

11[16]

Gu et al.(2006)

20-80

Guangdong(E)

2004

≥417/≥357

4496/1304

16115/10506

27.90/12.41

12[17]

Zhang et al.(2007)

28-88

Gansu(W)

2004

>440/>350

389/68

2372/360

16.40/18.89

13[18]

Luan et al.(2007)

21-72

Tibet(W)

Oct 2004 - Dec 2004

≥440/≥360

454/25

537/159

84.54/15.72

14[19]

Yao et al.(2007)

≥18

Shanghai(E)

Oct 2004 - June 2005

≥417/≥357

273/36

2965/2693

9.21/1.34

15[20]

Li et al.(2007)

20-59

Ningxia(W)

Jan 2004 - Dec 2005

>420/>350

410

9358

4.38

16[21]

Zeng et al.(2005)

18-85

Guangxi(W)

Jan 2004 - Aug 2005

≥417/≥357

490/170

2800/2400

17.50/7.08

17[22]

Mao et al.(2006)

≥20

Zhejiang(E)

Apr 2004-Dec2004

≥416/≥357

1214/160

7566/3450

16.05/4.64

18[23]

Diao et al.(2005)

20-79

Guangdong(E)

June 2004-June 2006

>357

0/853

0/7226

0/11.80

19[24]

Li et al.(2009)

22-60

Qinghai(W)

2004-2007

>420/>350

134/2

819/275

16.36/0.73

20[25]

Wu et al.(2007)

21-67

Zhejiang(E)

2005-2006

≥416/≥357

250

1492

16.76

21[26]

Sun et al.(2007)

20-70

Xinjiang(W)

Jan2005 - Dec2005

>417/>357

104/18

379/315

27.44/5.71

22[27]

Xie et al.(2008)

18-92

Chongqing(W)

June2005 - Dec2005

>380/>300

1244/483

5962/3566

20.87/13.54

23[28]

Fang et al.(2006)

20-90

Beijing(E)

Sept2005 - Dec2005

≥416.4/≥356.9

163/46

1181/762

13.80/6.04

24[29]

Cao et al.(2009)

>20

Zhejiang(E)

2005-2007

≥417/≥357

2516/651

9615/7639

26.17/8.52

25[30]

Wu et al.(2007)

19-87

Guangdong(E)

------

≥417/≥357

258/93

911/571

28.32/16.29

26[31]

Li et al.(2008)

>60

Guangdong(E)

2006

>420

156/45

519/425

30.06/10.59

27[32]

Jin et al.(2007)

26-57

Jilin(E)

------

≥408/≥357

97/2

350/32

27.71/6.25

28[33]

Chen et al.(2009)

>20

Yunnan(W)

Jan 2006 - Dec 2006

>420/>350

580/343

3593/3912

16.14/8.77

29[34]

Wu et al.(2008)

>16

Guangdong(E)

Nov2006-Feb2007

≥417/≥357

369/217

1366/1422

27.01/15.26

30[35]

Zeng et al.(2008)

22-79

Hunan(W)

Dec 2006 - Jan 2007

≥417/≥357

405/103

1346/994

30.09/10.36

31[36]

Wanget al.(2008)

20-78

Heilongjiang(E)

Feb2006 - Jan 2008

≥417/≥357

502/125

2390/1824

21.00/6.85

32[37]

Tian et al.(2008)

≥35

Shanghai(E)

Mar2006 - Sept2006

>420/>350

425/451

1887/2943

22.52/15.32

33[38]

Wei et al.(2008)

20-70

Hebei(E)

May2006 - Dec 2006

≥420/≥350

197/86

1146/859

17.19/10.01

34[39]

Deng et al.(2007)

41-93

Liaoning(E)

Sept2006 - Nov2006

>416/>339

250/45

936/218

26.71/20.64

35[40]

Wen et al.(2007)

35-64

Shandong(E)

Sept2006 - Dec 2006

≥417/≥357

126/44

1979/2062

6.37/2.13

36[41]

Zeng et al.(2009)

≥20

Zhejiang(E)

2006-2007

≥417/≥357

1797/520

6591/5649

27.26/9.21

37[42]

Zhong et al.(2008)

22-92

Hunan(W)

2007

≥420/≥360

178/34

919/497

19.37/6.84

38[43]

Zheng et al.(2008)

20-92

Guangdong(E)

2007

≥420/≥350

4355/1239

18589/10526

23.43/11.77

39[44]

Huang et al.(2009)

60-90

Shanghai(E)

2007

≥420/≥360

288/139

1423/1466

20.24/9.48

40[45]

Chen et al.(2008)

20-90

Chongqing(W)

2007

≥417/≥357

4772/951

8352/7471

57.14/12.73

41[46]

Liu et al.(2008)

≥60

Zhejiang(E)

Oct2007 - Feb2008

>420

445/213

1964/3321

22.66/6.41

42[47]

Jia et al.(2009)

20-101

Hebei(E)

Jan2007-Nov2007

>401.52/>249.20

802/180

6703/1832

11.96/9.83

43[48]

Han et al.(2008)

19-87

Beijing(E)

Jan2007-Nov2007

≥417/≥357

139/61

540/580

25.74/10.52

44[49]

Yuan et al.(2009)

20-85

Zhejiang(E)

Nov 2007 - Dec2007

≥417/≥357

1607/243

4958/2562

32.41/9.48

45[50]

Gao et al.(2008)

18-94

Anhui(W)

Jan2007 - Dec 2007

>429/>340

2883/609

26066/13758

11.06/4.43

46[51]

Wu et al.(2009)

23-59

Guangxi(W)

Jan2007 - May2009

>420/>360

111/20

825/407

13.45/4.91

47[52]

Yang et al.(2009)

24-67

Tibet (W)

Jan2007 - May2009

≥417/≥357

646/136

1874/993

34.53/13.70

48[53]

Wang et al.(2008)

45-96

Zhejiang(E)

Jan2007 - June 2007

≥420/≥360

690/335

1796/3341

38.42/10.03

49[54]

Quan et al.(2008)

32-77

Jilin(E)

Mar 2007

≥420/≥350

42/29

468/686

8.97/4.23

50[55]

Liu et al.(2008)

27-82

Liaoning(E)

Apr 2007 - Apr 2008

>420/>350

220/139

1144/923

19.23/15.06

51[56]

Wang et al.(2008)

>16

Zhejiang(E)

May 2007

>420/>360

126/31

518/920

24.32/3.37

52[57]

Ding et al.(2008)

21-61

Jiangsu(E)

May 2007

>420/>340

11/7

118/239

9.32/2.93

53[58]

Zhang et al.(2009)

20-90

Guangdong(E)

Sept2007-Aug2008

≥417/≥357

1147/248

6137/2679

18.69/9.26

54[59]

Huang et al.(2009)

20-80

Fujian (E)

Jan2008 - Sept2008

>416/>339

9458/6046

24140/20034

39.18/30.18

55[60]

Li et al.(2009)

30-69

Guangdong(E)

Mar2008 - Oct2008

≥428/≥340

2043/629

9189/7128

22.23/8.82

56[61]

Wang et al.(2009)

60-98

Beijing(E)

July2008 - June2009

≥417

416/208

2295/2266

18.13/9.18

57[62]

Wang et al.(2009)

19-65

Zhejiang(E)

Aug2008

≥417/≥357

191/76

599/702

31.89/10.83

58[63]

Cao et al.(2010)

>20

Hainan(E)

Sept 2008-Nov 2008

≥417/≥350

181/23

663/150

27.30/15.33

59[64]

Jiang et al.(2010)

20-93

Beijing(E)

Mar2009 - Sept2009

≥417/≥357

290/96

2585/1722

11.22/5.57

https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-11-832/MediaObjects/12889_2011_Article_3602_Fig2_HTML.jpg
Figure 2

Forest plot of the studies for the male.

https://static-content.springer.com/image/art%3A10.1186%2F1471-2458-11-832/MediaObjects/12889_2011_Article_3602_Fig3_HTML.jpg
Figure 3

Forest plot of the studies for the female.

Table 2

The prevalence of hyperuricemia in different gender and area

China

Gender

Case/Total

(No. of Studies)

Pooled

Estimate (%)

95%CI(%)

Heterogeneity

     

I2 P-value

Northern

China

Male

8923/59413(n = 21)

19.6

15.7-24.1

49.8% 0.00

 

Female

2393/35231(n = 21)

8.4

6.6-10.5

49.2% 0.00

Southern

China

Male

44075/163902(n = 34)

22.7

19.6-26.1

49.9% 0.00

 

Female

17289/132111(n = 35)

8.8

7.1-10.8

49.9% 0.00

Eastern

China

Male

40056/166093(n = 41)

20.1

17.8-22.6

49.8% 0.00

 

Female

16645/131127(n = 42)

8.6

7.0-10.6

49.8% 0.00

Western

China

Male

12942/57222(n = 14)

26.8

17.3-39.0

50.0% 0.00

 

Female

3037/36215(n = 14)

8.5

6.5-11.2

49.5% 0.00

Total

Male

52998/223315 (n = 55)

21.6

18.9-24.6

49.9% 0.00

 

Female

19586/165620 (n = 55)

8.6

7.2-10.2

49.8% 0.00

Table 3

The prevalence of hyperuricemia in different age

China

Gender

Age

  

~30

31-40

41-50

51-60

61-70

>70

Northern

China

Male

11.6(8.8-15.1)

16.4(12.7-20.9)

20.9(16.0-26.7)

21.0(14.2-29.9)

17.3(14.4-20.6)

17.9(13.8-23.0)

 

Female

2.6(1.5-4.5)

3.8(2.4-5.9)

7.6(5.5-10.2)

14.3(9.1-21.7)

13.2(9.5-18.2)

20.2(14.4-27.6)

Southern

China

Male

16.8(11.4-24.2)

24.4(16.3-34.9)

24.9(19.6-31.2)

23.5(19.5-27.9)

22.6(19.7-25.7)

27.2(22.5-32.4)

 

Female

3.1(1.8-5.4)

3.6(1.7-7.6)

6.2(3.5-10.7)

15.1(11.1-20.2)

19.8(13.6-27.8)

25.3(17.6-35.0)

Eastern

China

Male

13.1(9.5-17.7)

17.4(13.4-22.2)

20.4(16.7-24.7)

19.6(16.4-23.2)

19.9(17.3-22.8)

24.2(21.0-27.7)

 

Female

2.6(1.5-4.6)

3.5(2.6-6.7)

6.8(4.2-10.6)

12.4(9.4-16.2)

15.3(10.7-21.6)

22.4(16.2-30.0)

Western

China

Male

17.5(6.3-40.1)

29.9(8.3-67.0)

31.0(18.8-46.4)

31.2(18.9-46.9)

25.6(18.7-27.0)

24.6(10.3-48.1)

 

Female

4.7(3.4-6.5)

4.2(2.6-6.7)

7.5(5.2-10.6)

22.9(11.7-39.8)

24.6(16.1-35.6)

31.1(24.5-38.6)

Total

Male

14.2(10.4-19.2)

20.1(15.3-26.0)

22.9(18.9-27.5)

22.3(18.8-26.2)

23.3(18.0-24.9)

24.1(20.6-28.0)

 

Female

2.8(1.8-4.5)

3.5(2.0-6.2)

6.6(4.5-9.7)

14.7(11.5-18.6)

16.8(12.5-22.4)

23.4(17.7-30.4)

Note: The I2 of all studies in the table ranged from 45% to 50%.

Discussion

The prevalence of hyperuricemia varies in different populations and areas. In Turkey [65], one study reported that 19% of the men and 5.8% of the women had hyperuricemia and the overall prevalence of hyperuricemia was 12.1% in the urban population. In Nepal [66], 3794 people which were from Chitwan districts were investigated, and the prevalence of hyperuricemia was 21.42%. In Seychelle [67], the cross-sectional health examination survey based on a population random sample which included 1011 subjects aged 25 to 64 years showed that the prevalence of hyperuricemia was 35.2% and 8.7% in men and women, respectively. In Thailand [68], an across-sectional study of 1381 patients who firstly participated in annual health examinations during the period of July 1999 through February 2000 reported that the prevalence of hyperuricemia was 10.6%, but it was 18.4% and 7.8% in men and women, respectively. In Java [69], the prevalence of hyperuricemia was investigated by a survey of a total population of 4683 rural adults and the result was 24.3%. In United States [70], the prevalence rate of asymptomatic hyperuricemia in the general population was estimated at 2-13%. The prevalence of gout and/or hyperuricemia increased about 2 cases per 1000 enrollees over 10 year (1990-1999) in the overall population. In Japan [71], a total of 9,914 individuals (6,163 men and 3,751 women aged from 18 to 89 years) who were screened at Okinawa General Health Maintenance Association was screened. The result showed that the prevalence of hyperuricemia was 25.8% and it was 34.5%, 11.6% in men and women respectively. In New Zealand [72], hyperuricemia was more common in Maori men (27.1%) than in European men (9.4%) and in Maori women (26.6%) than in European women (10.5%). In Saudi Arabia [73], the prevalence of hyperuricemia was only 8.84%. In Taiwan island of China [74], the prevalence of hyperuricemia was high to 49.4% in Ayatals, but it was only 27.4% in non-aborigines.

From the analysis, it was found that age and sex affected the serum uric acid levels and the prevalence of hyperuricemia:

The factor of age

It was found that the prevalence of hyperuricemia increased with the age in male and female. The prevalence was higher in male who were after 30 years old than that younger. But the point age was 50 in female. The physiologic and economic reasons may explain this difference. After 30 years old, the male would have a stable family and career. In female, the influence of sexual hormones may explain the point age. Young children of both sexes have equally low urate levels, so the prevalence is low. The study of Katrine demonstrated that the 45-64 age group was higher prevalence compared with the 18-44 age group [75]. Vitool's study showed that the prevalence were 4.3% and 1.3% in men and women, who were younger than 18 years, but it increased to 17.4% and 15.4% in the men and women from 30 to 39 [68]. A study about elderly people in Taiwan reported that Men at age 65 to 69 had the highest proportion of hyperuricemia which was 69.8%, but woman at age more than 80 had the higher prevalence which was 50% [76].

The factor of sex

From the previous studies, it was found that serum uric acid levels were higher in men than in women, but it tended to be consistent between man and woman after the age of 50 [77, 78]. The study of Gordon explained it that serum uric acid level increased after the menopause in females which attributed to the influence of sexual hormones [79]. The results of the study showed that male subjects had a higher prevalence of hyperuricemia than women, which was in line with findings of many studies from different countries [6574].

Health Education and life customs

From the result of meta-analysis, it was found that the prevalence in different age of southern China was higher than that in northern China and the prevalence in western was higher than that in eastern, especially in male. The reason for that may be different life customs. In southern China, the mainly food is rice and it is sweat in northern China. In the eastern China, the health service is better than that in western China. More health educations were carried out and the people had more health knowledge in eastern China, which may affect the prevalence of hyperuricemia. The reasons for the difference in prevalence need further research.

Conclusions

In conclusion, aging trend is more and more serious in China, even all the word, and the prevalence of hyperuricemia is higher in elderly. It was found that urate levels correlate with many recognized cardiovascular risk factors, including hypertension, diabetes mellitus, hypertriglyceridemia, obesity and insulin resistance. Multiple Risk Factor Intervention Trial (MRFIT) database showed that hyperuricemia was an independent risk factor for acute myocardial infarction [75]. The Italian Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study showed that serum urate levels in the highest quartile were associated with increased risk of all cardiovascular events (relative risk [RR] = 1.73) and fatal cardiovascular events (RR = 1.96) compared with urate levels in the second quartile[76]. So it is important to control the prevalence in elderly. Interventions are necessary to change the risk factors before the key age which is 30 years in male and 50 in female. At the same time, intervention to high risk group is urgent.

In China, most of the studies concerned the eastern, especially in the urban areas, but it is necessary to study the western of China and rural areas. The cohort study with larger sample is necessary. This article only provides the narrowing window of hyperuricemia in China.

Notes

Declarations

Authors’ Affiliations

(1)
Jinan Institute of Cardiovascular Disease, The Fourth People's Hospital of Jinan
(2)
Department of Public Health, The Second Affiliated Hospital of Soochow University

References

  1. Vazquez-Mellado J, Alvarez Hernandez E, Burgos-Vargas R: Primary prevention in rheumatology: the importance of hyperuricemia. Best Pract Res Clin Rheumatol. 2004, 18 (2): 111-124. 10.1016/j.berh.2004.01.001.View ArticlePubMedGoogle Scholar
  2. Lin KC, Lin HY, Chou P: The interaction between uric acid level and other risk factors on the development of gout among asymptomatic hyperuricemic men in a prospective study. Journal of Rheumatology. 2000, 27: 1501-1505.PubMedGoogle Scholar
  3. Alderman MH, Cohe H, Madhavan S, Kivlighn S: Serum uric acid and cardiovascular events in successfully treated hypertensive patients. Hypertension. 1999, 34: 144-150.View ArticlePubMedGoogle Scholar
  4. Bos MJ, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM: Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam Study. Stroke. 2006, 37: 1503-1507. 10.1161/01.STR.0000221716.55088.d4.View ArticlePubMedGoogle Scholar
  5. Bonora E, Targher G, Zenere MB, Saggiani F, Cacciatori V, Tosi F, et al: Relationship of uric acid concentration to cardiovascular risk factors in young men. Int J Obes Relat Metab Disord. 1996, 20: 975-980.PubMedGoogle Scholar
  6. Miao Zh-M, Zhao Sh-H, Wang YG, Li Ch-G, Wang Zh-Ch, Chen Y, et al: Epidemiological survey of hyperuricemia and gout in coastal areas of Shandong Probince. Chin J Endocrinol Metab. 2006, 22 (5): 421-425.Google Scholar
  7. Du S, Chen Sh-L, Wang Y, Xu LQ: The epidemiological of hyperuricemia and gout in a community population of Huangpu district in Shanghai. Chin J Rheumatol. 1998, 2 (2): 75-78.Google Scholar
  8. Huang RG, Song XH: The relationship between the serum uric acid and hypertension. Chin J Convalescent Med. 2006, 15 (6): 404-406.Google Scholar
  9. Li H, Zhang MX, Xiao J: The prevalence of hyperuricemia, people from the government office in Henan. Journal of Zhengzhou University(Medical Sciences). 2002, 37 (1): 87-88.Google Scholar
  10. He XQ, Hao R, Zheng YP: The analysis of uric acid levels about 2486 people. Chengdu Medical Journal. 2003, 29 (4): 203-204.Google Scholar
  11. Shao JH, Mo BQ, Yu RB, Li Zh, Liu H, Xu Y-CH: Epidemiological study on hyperuricemia and gout in community of Nanjing. Chin J Dis Control Prev. 2003, 7 (4): 305-308.Google Scholar
  12. Wang Y: The analysis of uric acid levels about 1000 people. Chinese Journal of Rural Doctor. 2004, 11 (6): 18-Google Scholar
  13. Yu JW, Lu JB, Zhang XJ, Yang YB, Liu BL, Yu SH-Y: The Analysis of Blood Uric Acid Level and the Indications Associate with Hyperuricemiain 13324 Foshan' s Inhabitants. Chinese Journal of Integrated Traditional and Western Nephrology. 2005, 6 (7): 401-403.Google Scholar
  14. Yu JW, Lu JB, Zhang XJ, Yang YB, Liu BL: Study on hyperuricemia with hyperlipaemia, high blood sugar and hypertension in 1320 elderly people. Chin J Epidemiol. 2005, 26 (6): 455-457.Google Scholar
  15. Zhang X-SH, Yu WG, Yu LX, Zhang LY, Yu Y: An epidemiologic study on hyperuricaemia and gout in residents of coastal areas of Hai yang City in Shan dong. Chin J Gen Pract. 2006, 5 (4): 216-219.Google Scholar
  16. Gu P: The incidence of hyperuricemia in 26621 health check up persons in Guangzhou City and analysis of associated diseases. China Tropical Medicine. 2006, 6 (6): 1082-1084.Google Scholar
  17. Zhang WX, Chen H, Yue ZH-F: The investation of hyperuricemia in Lan zhou, people from government office. Vocation Education. 2007, 25 (9): 130-131.Google Scholar
  18. Luan M, Wang SH-B, Chen Y, Guan ZH-F: The incidence of hyperuricemia in 696 who from Tibet. Chin J Prev Med. 2007, 41 (2): 143-144.Google Scholar
  19. Yao ZL, Jiang SH-J, Liu H, Wan XQ, Ding ZH-G: Epidemiological study on hyperuricemia and gout in the coastal area of Qingdao city. Chin J Rheumatol. 2007, 11 (11): 672-675.Google Scholar
  20. Li J, Wang TR, Wu XY: The analysis of the result about young and Middle-aged physical examination. Ningxia Med J. 2007, 29 (4): 369-370.Google Scholar
  21. Zeng XG: The epidemiological of hyperuricemia and gout about railway workers in Nanning. Heilongjiang Medical Journal. 2005, 29 (11): 876-877.Google Scholar
  22. Mao Y-SH, Zhou LN, Ye HY, Huang T, Chen CH-X, Du J, et al: Epidemiological survey on prevalence of hyperuricemia and gout in staff of a petrchemical corporation in Ningbo. Chin J Endocrinol Metab. 2006, 22 (4): 338-341.Google Scholar
  23. Diao WX, Yu JW, Zhu J, Zhang XJ, Yu SH-Y, Liu BL: The survey on uric acid levels in female from Foshan, Guangdong. New Medicine. 2007, 38 (10): 667-668.Google Scholar
  24. Li YM: The prevalence of hyperuricemia and dietary intervention in Xi'ning. Qinghai Medical Journal. 2009, 39 (8): 80-81.Google Scholar
  25. Wu XH, Wu SH-ZH, Xu HL: The analysis of metabolic syndrome in physical examination from 1492 people. Zhejiang Prev Med. 2007, 19 (8): 19-20.Google Scholar
  26. Sun YP, Yao H, Aimulajing M, Cai ZH-H, Nuermaimait K, Gulinisha K, et al: The analysis of uric acid level and the prevalence of hyperuricmia in Uygur ethnic population. Journal of Xinjiang Medical University. 2007, 30 (5): 458-460.Google Scholar
  27. Xie WB, Wang YX, Zhang MJ, Xie YH, Song L, Lu Y: Study on the relationship between hyperuricemia and lipid metabosism, hyperten abnormality, and barc index by 9528 examples of their health examination in Chongqing. Journal of Chongqing Medical University. 2008, 33 (7): 843-846.Google Scholar
  28. Fang WG, Huang XM, Wang Y, Zhu WG, Bie ZH-X, Chen JL, et al: A Cross-sectional study of hyperuricemia in state-employees in Beijing: prevalence and risk factors. Natl Med J China. 2006, 86 (25): 1764-1768.Google Scholar
  29. Cao LJ, Hong XP: Analysis of serum uric acid level in a population of Zhenhai district. Laboratory Medicine. 2009, 24 (11): 804-807.Google Scholar
  30. Wu WR, Guo JM, Yang W, Luo HB: The prevalence of hyperuricemia and gout among 1482 subjects for health check in Guangzhou. Hainai Medicine. 2007, 18 (9): 110-112.Google Scholar
  31. Li H, Zhang J: The relationship between hyperuricemia and risk factors in People aged intellectuals. Guangdong Medical Journal. 2008, 29 (10): 1735-1736.Google Scholar
  32. Jin X, Jiang CH-SH, Jin CH-H: Analysis on the prevalence of hyperuricaemia among the policeman in Yanbian. Modern Preventive Medicine. 2007, 34 (21): 4156-4157.Google Scholar
  33. Chen XY, Yang HD, Yang JY: The prevalence of hyperuricemia and gout about Urban residents in Dali, Yunnan. China Prac Med. 2009, 4 (10): 257-259.Google Scholar
  34. Wu WR, Gui JR, Yang W, Zhong ZH-G, Liu YH, Luo HB: Epidemiology of Hyperuricemia and Gout in a Community in Guangzhou. Chinese Journal of General Practice. 2008, 6 (7): 728-729.Google Scholar
  35. Zeng Y-CH, Huang X, Zhou GY, Hu MY: The prevalence of hyperuricemia and related factors in Changsha. Journal of Hygiene Research. 2008, 37 (6): 679-681.Google Scholar
  36. Wang JM, Jin JY, Li CH-J: The survy on hyperuricemia in Jiamusi. China Modern Doctor. 2008, 46 (23): 77-78.Google Scholar
  37. Tian XC, Jiang Z-CH, Bao G-CH, Gao WG, Nan HR, Wang SH-J, et al: Analysis on prevalence and influence factors of hyperuricemia among residents in Qingdao. Chin J Pubic Health. 2008, 24 (3): 360-362.Google Scholar
  38. Wei GX, Gao CH-H, Si RJ, Jiang PF, Liu W-ZHL: The prevalence of hyperuricemia and related factors in the town of Xinglong, Chengde. Chin J Misdiagn. 2008, 18 (16): 4022-4023.Google Scholar
  39. Deng SH-SH, Zhang Q, Wang XF, Cao CP, Sun G, Meng J, et al: The current conditions of serum uric concentrations in parts of the middle-aged and elderly population of Shenyang. Journal of China Medical University. 2007, 36 (6): 712-714.Google Scholar
  40. Wen XY, Lu FH, Yang JM, Liu ZH-D, Zhou XH, Jin SH-K, et al: Analysis on hyperuricemia and its influential factors in population. Chin J Pubic Health. 2007, 23 (12): 1520-1522.Google Scholar
  41. Cao LJ, Li QW: The analysis of Metabolic indicators about physical examination from one government office. Shanghai Journal of Preventive Medicine. 2009, 21 (4): 171-172.Google Scholar
  42. Niu X, He QN, Lin YP, Zhou G, Zeng WH: The analysis about hyperuricemia and related diseases in teachers groups. Chin J Pubic Health. 2008, 24 (1): 118-119.Google Scholar
  43. Zheng ML, Lai YH, He XN, Tan FW: Correlation of detection of hyperuricemia with hypertension in healthy population in Guangzhou City. China Tropical Medicine. 2008, 8 (3): 512-514.Google Scholar
  44. Huang SH-X: The analysis of hyperuricemia and related diseases in elderly people. PJCCPVD. 2009, 17 (8): 675-676.Google Scholar
  45. Chen YQ: The prevalence of hyperuricemia and related factors which is from urban population in Chongqing. Journal of Third Military Medical University. 2008, 30 (11): 1013-1014.Google Scholar
  46. Liu CL, Wang WW, Chen J, Zhou W: The analysis of glucose, liver and renal function about elderly people in Wenzhou. Experimental &Lab Med. 2008, 26 (4): 397-399.Google Scholar
  47. Jia YH, Cui LF, Yang WH, Shu R, Song H-CH, Han YX, et al: Epidemiological survey on morbidity of hyperuricemia and gout in Tangshan Mining district. Chinese Journal of Coal Industry Medicine. 2009, 12 (12): 1933-1935.Google Scholar
  48. Han XH, Yao XY, Fang X-SH: The prevalence of hyperuricemia and abnormal of lipid and glucose in Medical examination population. Shanxi Med J. 2008, 37 (5): 438-439.Google Scholar
  49. Yuan HP, Hu XF, Liu XG, Bao ZH-J: Analysis on detection of hyperuricemia for cadres in island areas and strategies. Nursing and Rehabilitation. 2009, 8 (3): 188-189.Google Scholar
  50. Gao CH-J, Jiang YG, Tang ZH-L: The epidemical analysis of hyperuricemia to 39824 people in Anhui. The Journal of Practical Medicine. 2008, 24 (20): 3589-3590.Google Scholar
  51. Wu J-EN, Chen F: The survy of the prevalence of hyperuricemia in 1230 government officials. China Prac Med. 2009, 14 (32): 206-Google Scholar
  52. Yang C, Liu G-ZH, Liu YX, Feng GJ: Hyperuricemia in Tibetans Undergoing Health Examination in Linzhi District in Tiebet. Military Medical Journal of South China. 2009, 23 (6): 10-12.Google Scholar
  53. Wang SP, Zhang WJ, Hong JX: A Study of Morbidity and Cor r elative Factors of Hyperuricemia Among Middle and old Aged People. Chinese Primaty Health Care. 2008, 22 (1): 71-73.Google Scholar
  54. Jin ZH-Y, Han CH-J, Yu XL: The survy of uric acid levels in Han and Korean. Chinese Journal of Clinical Laborat ory Science. 2008, 26 (5): 386-387.Google Scholar
  55. Liu MK, Yu Y-ZH, Dong F-ZH, Yu JL: Examination and Analysis of Blood Uric Acid Level in 2067 Inhabitants of Dalian. Practical Preventive Medicine. 2008, 15 (5): 1602-1604.Google Scholar
  56. Wang LJ, Fu HP, Sun Y, Cai WH: A Survey of Metabolic Syndrome and its Related Diseases in Fishing Village in Island. Zhejiang Prev Med. 2008, 20 (10): 8-10.Google Scholar
  57. Ding YH: The analysis of hyperuricemia in Hospital staff. Jiangxi Medical Journal. 2008, 43 (3): 261-Google Scholar
  58. Zhang Y, Feng L, Huang LW: Study on relationship between epidemic characteristics and Metabolic syndrome. 2009, 9 (7): 10-13.Google Scholar
  59. Huang HB, Jin HW, Chen ZH-SH: The analysis of hyperuricemia about medical examination population in Xiamen. Henan J Prev Med. 2009, 20 (5): 345-347.Google Scholar
  60. Li ZH: Investigation of the level of blood uric acid, blood lipid and hypertension in dongguan. Modern Hospital. 2009, 19 (4): 154-155.Google Scholar
  61. Wang J, Gu X-EN, Jiang Y, Yin ZH-N: Analysis of the detection of hyperuricemia in eldly people. Chinese Journal for Clinicians. 2009, 37 (3): 47-48.Google Scholar
  62. Liu QF, Guo LJ, Chen SH-P: The analysis of healthy conditions about rural teachers in Liandu, Lijiang. Chinese Primary Healthy Care. 2009, 23 (11): 114-115.Google Scholar
  63. Cao YJ, Liu Y, Li T, Yan BS, Wang ZH-ZH, Yang XL: Investigation of the increasing of policemen in blood uric acid and Triglyceride in Haikou. Hainan Medical Journal. 2010, 21 (1): 120-121.Google Scholar
  64. Jiang Y: The analysis of serum uric acid levels in healthy people in Beijing. Chinese Journal of Coal Industry Medicine. 2010, 13 (2): 271-Google Scholar
  65. Ismail S, Servet A, Betul P, Ali RS, Oguz G, Merih B, et al: Hyperuricemia and its related factors in an urban population, Izmir, Turkey. Rheumatol Int. 2009, 29: 869-874. 10.1007/s00296-008-0806-2.View ArticleGoogle Scholar
  66. Kumar S, Singh AR, Takhelmayum R, Shrestha P, Sinha JN, et al: Prevalence of hyperuricemia in Chitwan District of Nepal. Journal of college of Medical Sciences-Nepal. 2010, 6 (2): 18-23.Google Scholar
  67. Conen D, Wietlisbach V, Bovet P, Shamlaye C, Riesen W, Paccaud F, et al: Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country. BMC Public Health. 2004, 4: 9-10.1186/1471-2458-4-9.View ArticlePubMedPubMed CentralGoogle Scholar
  68. Vitoon J, Rungroj K, Thananya B, Kamol U, Suthipo U: Prevalence of Hyperuricemia in Thai Patients with Acute Coronary Syndrome. Thai Heart J. 2008, 21: 86-92.Google Scholar
  69. Darmawan J, Valkenburg HA, Muirden KD, Wigley RD: The epidemiology of gout and hyperuricemia in a rural population of Java. J Rheumatol. 1992, 19: 1595-1599.PubMedGoogle Scholar
  70. Edward W, Campion MD, Robert J, Glynn SD, Lorraine O, Delabry MA: Asymptomatic hyperuricemia. Risks and consequences in the normative aging study The American Journal of Medicine. 1987, 82 (3): 421-426.Google Scholar
  71. Kazufumi N, Kunitoshi I, Taku I, Takashi T, Yosiharu I, Shuichi T: Hyperuricemia and Cardiovascular Risk Factor Clustering in a Screened Cohort in Okinawa, Japan. Hypertens Res. 2004, 27: 227-233. 10.1291/hypres.27.227.View ArticleGoogle Scholar
  72. Patrick K, Shelley AS, Benjamin C, Robertson MC: Gout is on the increase in NewZealand. Annals of the Rheumatic Diseases. 1997, 56: 22-26. 10.1136/ard.56.1.22.View ArticleGoogle Scholar
  73. Abdurhman SA-A: Hyperuricemia in Saudi Arabia Rheumatol Int. 2001, 20: 61-64.Google Scholar
  74. Huang CL, Chen KT: An epidemiological survey of hyperuricemia among the Atayals of Nanau Township, Iian county. Epidemiology Bulletin. 1996, 12 (5): 71-81.Google Scholar
  75. Krishnan E, Baker JF, Furst DE, Schumacher HR: Gout and the risk of acute myocardial infarction. Arthritis Rheum. 2006, 54: 2688-2696. 10.1002/art.22014.View ArticlePubMedGoogle Scholar
  76. Verdecchia P, Schillaci G, Reboldi G, Santeusanio F, Porcellati C, Brunetti P: Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PIUMA study Hypertension. 2000, 36: 1072-1078.View ArticlePubMedGoogle Scholar
  77. Freedman DS, Williamson DF, Gunter EW, Byers T: Relation of serum uric acid to mortality and ischemic heart disease. The NHANES I epidemiologic follow-up study. Am J Epidemiol. 1995, 141: 637-644.PubMedGoogle Scholar
  78. Culleton BF, Larson MG, Kannel WB, Levy D: Serum uric acid and risk for cardiovascular disease and death: The Framingham Heart Study. Ann Intern Med. 1999, 131: 7-13.View ArticlePubMedGoogle Scholar
  79. Gordon T, Kannel WB: Drinking and its relation to smoking, blood pressure, blood lipids, and uric acid. The Framingham Study Arch Int Med. 1983, 143: 1366-1374.View ArticleGoogle Scholar
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    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/11/832/prepub

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